Diagnosis of Pediatric Acute Abdominal Pain

by Carlo Raj, MD

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    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.

    About the Lecture

    The lecture Diagnosis of Pediatric Acute Abdominal Pain by Carlo Raj, MD is from the course Pediatric GI Pathology.

    Included Quiz Questions

    1. Mittelschmerz
    2. Incarcerated hernia
    3. Intussusception
    4. Volvulus
    5. Urinary tract infection
    1. Stabilize the patient and administer a urine pregnancy test after consent.
    2. Stabilize the patient and check for serum electrolytes.
    3. Arrange for an elective ultrasound scan.
    4. Prepare for diagnostic laparoscopy.
    5. Arrange for blood after grouping and crossmatching.
    1. Ectopic pregnancy
    2. Acute gastroenteritis
    3. Chronic pelvic inflammatory disease
    4. Uncomplicated acute appendicitis
    5. Mittelschmerz
    1. Vaso-occlusive crisis
    2. Autosplenectomy
    3. Infection
    4. Trauma
    5. A tumor

    Author of lecture Diagnosis of Pediatric Acute Abdominal Pain

     Carlo Raj, MD

    Carlo Raj, MD

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