Acute Abdominal Pain

‘Medical’ common causes:

– Viral gastroenteritis

– Mesenteric adenines

– UTI/ Pyelonephritis

– Constipation

– Pneumonia

– Tonsillitis / Pharyngitis

– Flare-up of IBD

– Dysmenorrhoea

– Henoch-Schönlein Purpura

– DKA, Sickle crisis, Renal calculi

‘Surgical’ common causes:

– Acute appendicitis

– Intussusception

– Peritonitis

– Bowel obstruction

– Volvulus / Malrotation

– Incarcerated Hernia

– Tortion of ovary / testes

– Tumour / ruptured cyst

– Gallstones

– Ectopic pregnancy

History:

– Pain: location, severity, pattern, timing

(SOCRATES)

– Any Vomiting: frequency? projectile?

any bile / blood? worsening?

– When last ate & last bowel movement?

– Bowels: Diarrhoea, Constipation, blood in stools?

– Fever? duration, high-grade?, rigors?

– Urinary symptoms?

dysuria, frequency, incontinence, hematuria

– Any trauma/ injury?

– Any lumps noted in abdominal or groin?

– Travel abroad / to animal farm?

– Known illness?

In teenage girls:

– Menstrual history, LMP

– Any PV discharge

– Sexually active? any contraception?

– Could pregnancy be possible?

Examination:

– Temp, HR, RR, SaO2

– Alertness, interactive? Active?

– Able to hop-skip-jump? Gait? Peritonism?

– ENT examination

– Rashes (e.g. HSP)

– Abdomen soft/ rigid? Guarding?

– Any palpable mass?

– Any visible peristalsis?

– Bowel sounds- absent/ ‘tinkering’

– Hernial sites

– Auscultate chest (basal pneumonia?)

Common initial investigations:

– FBC, U&E, LFT, CRP, Amylase, Lactate, Glucose

– Urinanalysis: dipstick, microscopy & culture

– Urine pregnancy test (in teenage girl, with consent)

– USS Abdo & Pelvis

Consider if relevant:

– Abdominal xray

– Chest xray

– CT/ MRI Abdo

– Stool analysis

– Diagnostic laparoscopy

Management: (Guided by initial assessment)

If suspecting surgical cause:

– Inform surgical team

– Do initial investigations

– Keep Nil By Mouth

– IV fluids (maintenance)

– Offer analgesia

– Consider need for NGT

No investigation needed if simple cause suspected.

– May need initial investigations to exclude serious causes

– Focus investigations to likely differentials

– Consider observation / admission if cause is unclear

– Seek senior opinion if unsure

– Avoid laxatives if ‘surgical cause’ possible

– Agree management of likely cause

– Safety-netting if discharging

Further references:

Leung AKC; Sigalet DL Acute abdominal pain in children. American Family Physician. June 1, 2003. Vol.67,Iss11; pg.2321

Hijaz NM, Friesen CA. Managing acute abdominal pain in pediatric patients: current perspectives. Pediatric Health Med Ther. 2017;8:83–91.