Acute Abdominal Pain

Abstract

1. Robert D. Baker, MD, PhD* 1. *Department of Pediatrics, Digestive Disease and Nutrition Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY * Abbreviations: CRP: : C-reactive protein CT: : computed tomography DRE: : digital rectal examination ERCP: : endoscopic retrograde cholangiopancreatography GI: : gastrointestinal HIDA: : hydroxyiminodiacetic acid IV: : intravenous MRI: : magnetic resonance imaging TPN: : total parenteral nutrition WBC: : white blood cell Children frequently have acute abdominal pain. The physician must identify which child has a potentially catastrophic condition (<2%). Because the number of patients requiring immediate action is low, the physician can be lulled into a sense of safety. Infrequently, acute abdominal pain can be catastrophic, so the physician needs to be cognizant of conditions requiring action. Knowledge and judgment are key. After completing this article, readers should be able to: 1. Understand the causes and frequency of acute abdominal pain in childhood. 2. Develop a differential diagnosis based on age and symptoms. 3. Formulate a plan for evaluation and management of acute abdominal pain. 4. Choose the appropriate imaging study for various diagnoses. Acute abdominal pain is a frequent and challenging problem facing pediatricians. The cause of acute abdominal pain can range from John Apley’s “little bellyacher” (1) to an emergency requiring immediate action. Assessing acute abdominal pain is a situation that requires excellent clinical acumen, an area where pediatricians should “prove their worth” by outperforming other primary caregivers. Making the correct diagnosis may earn the pediatrician accolades for saving a life (as in the case of intussusception or midgut volvulus) but may also not win friends (as when a mother is informed that the reason for her child’s excruciating pain is constipation). A mistaken diagnosis can have devastating results, either by not acting when action is called for or by performing unnecessary tests and procedures. Because the differential diagnosis list for acute abdominal pain is long, a logical approach is to consider diagnoses by age group. Convenient age divisions …