Acute abdominal pain How to approach children How

Acute abdominal pain

How to approach children? • How to take a history? – Basic: when, acute or insidious onset, duration, persistent or intermittent, location, character, other associated symptoms (fever, vomiting/diarrhea, cough, etc. ), activity/appetite, stool passage, past history. – Children < 2 y/o cannot answer your question. caregiver? Parents? – Chief complaint of an infant may be only intermittent/ or inconsolable crying. – Appearance: apprehensive or easy looking? Walking/running or bending posture

How to approach children? • How to perform physical examination? – Crying child/infant: PE of abdomen is impossible. – 可讓父母將小孩抱在懷裡，減少小孩的焦慮， 等比較不哭時，再去做PE。 – Peritoneal sign: tenderness, rebounding pain, 不讓人摸肚子, muscle guarding(+/-), pain while jumping

Causes of acute abdominal pain • Medical: – – – – – Gastroenteritis Constipation Urinary tract infection Urolithiasis Ovarian torsion and cyst Ectopic pregnancy Pelvic inflammatory disease Cholecystitis Biliary colic - Pancreatitis - Inflammatory bowel disease - Henoch-Schönlein purpura - Ulcer disease - Meckel’s diverticulitis

Causes of acute abdominal pain • Surgical: – Appendicitis – Intussusception – Malrotation with midgut volvulus – Incarcerated inguinal hernia – Testicular torsion – Hollow organ perforation