Acute abdominal pain is a common symptom in the pediatric population. As with adults, surgical causes must be excluded, but in children there is greater urgency due to lower physiological reserves. Being aware of the differential diagnoses of acute abdominal pain in children, both surgical and medical, is important knowledge for students, in addition to details about the assessment and management of key conditions. Differential diagnosis can be accurately assessed by the age of the child.
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Differential Diagnosis of Pediatric Acute Abdominal Pain

There are a variety of conditions that may cause acute abdominal pain in a child.The age of child determines the differential diagnosis.

Differential diagnosis of acute abdominal pain by predominant age :

Infants and toddlers School aged toddlers Adolescents
Malrotation Gastroenteritis Appendicitis
Incarcerated hernia Appendicitis Pelvic Inflammatory Disease
Meckel diverticulum Respiratory infections Pregnancy
Intussusception Urinary tract infections Dysmennorhea
Volvulus Diabetic ketoacidosis Ovarian/ testicular torsion
Urinary Tract Infection Trauma Pancreatitis


Hirchsprung”s disease Henoch-Scholein purpura Appendicitis
constipation Mesenteric lymphadenitis cholecystitis
  constipation Inflammatory bowel disease

The causes of abdominal pain in a child are divided into surgical causes, medical causes, and non-specific abdominal pain.

 Causes of abdominal pain Details
Surgical causes
 Acute appendicitis Classically begins as peri-umbilical pain that then migrates to the right iliac fossa, seen in school aged children and adolescents
Intussusception  Most common between 3 and 18 months of age. Intermittent attacks of abdominal pain with screaming, pallor and drawing of legs.
Volvolus Occurs secondary to malrotation in an infant who classically presents with bilious vomiting due to small bowel obstruction.
Strangulated inguinal hernia Tender groin lump present.
Peritonitis Generalized tenderness with signs of peritonism, including guarding and rigidity. The patient may lie still to avoid provocation of pain.
 Pancreatitis Epigastric or left upper quadrant pain that radiates to the back.
Testicular torsion Seen in adolescents ,Tender, swollen testes.
Trauma Mostly found in school aged children, History or signs of trauma present.
 Medical causes
Gastroenteritis Triad of fever, diarrhea and abdominal pain
Hepatitis Pain in the right upper quadrant
Inflammatory bowel disease May be associated with episodic abdominal pain over a long time period.
Constipation  Common in infants and school aged children
Lower lobe pnuemonia Referred pain to upper abdomen accompanied by respiratory symptoms.
 Urinary tract infection Presence of urinary symptoms such as dysuria.
Diabetic ketoacidosis Associated with hyperglycemic symptoms of polyuria, polydipsia and polyphagia, and dehydration.

Other causes of pediatric acute abdominal pain include:

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