Diagnosis of Pediatric Acute Abdominal Pain

00:01 Pediatric acute abdominal pain.

00:04 Things that you want to keep in mind, acute abdominal pain.

00:07 We’ll be focusing upon the following: Acute gastroenteritis being the most common.

00:12 We’ve talked about rotavirus as being the – the virus being very common.

00:16 We also talked about salmonella, Campylobacter jejuni so and so forth.

00:21 Let’s start talking about ages here once again.

00:23 Acute abdominal pain.

00:26 Less than two years of age: trauma, intussusception, incarcerated hernia.

00:33 What does that mean? This was an inguinal hernia which went through the inguinal canal.

00:39 It became – What became? The intestine became strangulated.

00:44 It became incarcerated.

00:46 What are you worried about in acute abdominal pain? Rupture, peritonitis and death.

00:52 Volvulus, urinary tract infection.

00:54 Less than two years of age.

00:55 2 to 5: African-American, sickle cell anemia.

01:01 What does that mean to you? This means that there is vaso-occlusive crisis especially when this African-American is playing.

01:09 There’s sickling of the RBC, therefore, decreased blood supply to the, maybe perhaps, the mesentery.

01:16 Welcome to acute abdominal pain with sickle cell anemia.

01:20 Even amazingly -- look at this, this is no joke -- Lower lobe pneumonia, more common than you would think in clinical practice.

01:28 This is a child and you're thinking, “Dr. Raj, is that a mistake? You’re saying pneumonia causing acute abdominal pain?” When the lungs are in the chest, remember this is a child, so therefore, lower lobe pneumonia which is right above the diaphragm is going to be very close to his abdomen, and in a child between ages of two to five years of age, in fact, is a very common cause of acute abdominal pain.

01:55 And the x-ray here may or may not even show changes in a child.

01:59 So it behaves atypical. Keep that in mind. Big time.

02:03 Urinary tract infection here as well.

02:05 Older children, so now we’re getting into eight years, ten years, eleven years and such, and we have appendicitis.

02:13 Mittelschmerz, ectopic pregnancy and pelvic inflammatory disease Many of these are actually very much in a female.

02:20 Mittelschmerz means -- Remember, in the middle of the menstrual cycle is when the egg egg is being released from the ovary.

02:28 Picture that.

02:29 The follicles rupturing from the ovary, there goes the egg.

02:33 Who’s going to catch it? “I got, I got it.” Who’s the mitt? Who’s the catcher? The fallopian tube and the fimbriae.

02:42 And during that time when the follicle ruptures, you might get a little bit of blood in the peritoneum.

02:48 That will cause acute abdominal pain in a female.

02:51 Welcome to mittelschmerz.

02:53 And we have ectopic pregnancy.

02:55 Think about ectopic pregnancy.

02:58 As the egg which has not been fertilized instead of being planted in the uterus in that female may get then obviously trapped in the fallopian tube.

03:08 Acute abdominal pain and PID being one of the most common causes of ectopic pregnancy.

03:14 Use common sense, use the information that we’ve accumulated, accumulated, accumulated, and go with the ages here and make the correct diagnosis.

03:24 Age becomes, as you can see here, incredibly important for differentials.

03:30 Diagnosis, all etiologies.

03:33 GI, reproductive, renal, all of that area.

03:37 Consider CBC to help you figure out.

03:40 Urine analysis becomes important.

03:42 Pregnancy test.

03:43 Maybe it’s pancreatitis, right? Pancreatitis.

03:47 Cystic fibrosis, pancreatitis, abdominal pain.

03:50 Liver function tests, chest x-ray, abdominal x-ray, CT scan, depending as to what your cause is.