Acute Abdominal Pain by Age
Common to Uncommon
| Age | Neonate | 2 m- 2yrs | 2 m - 5 yrs | >5 yrs |
| ER | Volvulus | Trauma | Trauma | Appendicitis |
| NEC | Incarcerated hernia | Appendicitis | Trauma | |
| Adhesions | Intussusception | Intussusception | DKA | |
| Foreign body ingestion | Foreign body ingestion | PPU | ||
| Hirschsprung disease | Adhesions | Adhesions | ||
| Adhesions | HUS | HUS | ||
| HUS | Primary bacterial peritonitis | Myocarditis/pericarditis | ||
| Primary bacterial peritonitis | ||||
| Common/ER | Colic | AGE | AGE | AGE |
| Viral illness | Viral illness | Viral illness | ||
| Pharyngitis | Constipation | |||
| Constipation | Pharyngitis |
Acute Abdomen
1. Trauma
A. Motor vehicle collisions, falls, child abuse
2. Appendicitis
A. Most predictive: RLQ pain, abd. wall rigidity, and migration of periumbilical pain to the RLQ
B. Pediatric Appendicitis Score (PAS)
1. For 1-17 y/o, total 10 pts
2. Point System:
a. 2 pts: cough/percussion/hopping tenderness; RLQ tenderness;
b. 1 point: fever > 38° C, anorexia, N/V, migration of pain, WBC >10 000 cells/mm3 , and PMN >7500 cells/mm3
3. Score
PAS≧ 7: dx of appendicitis
PAS 3-6: Need image studies
PAS≦ 2: exclusion
(Reference: Journal of Pediatrics 153.2 (2008): 278-282)
C. Perforation rarely occurs within the first 24 hrs
3. Intussusception
A. 2 months - 2 yrs, peak at 6 months
B. Triad (<15%):
1. Intermittent, colicky pain (88%)
2. Palpable sausage-shaped abd. mass (48%)
3. Currant-jelly stool (25%)
Others: Inconsolable crying, drawing legs towards abd., bilious emesis. 15-20 min intervals. Progressive
C. Dx: Ultrasound
1. Target sign/coiled spring sign
2. Most common: ileocolic (95%)
D. Tx:
1. Hydrostatic (ex. Barium) /pneumatic enema under Ultrasound guidance <48 hrs of onset
2. Surgery (esp. small bowel)
4. Malrotation with midgut volvulus
1. S/S: Bilious/Non-bilious vomiting + abd. pain
5. Incarcerated inguinal hernia
1. S/S: irritable and crying, vomiting, abdominal distention, palpation of a firm inguinal mass that may extend to scrotum/labia majora in the groin
6. Adhesions with intestinal obstruction
1. Hx of abd. surgery + abd. pain
7. Necrotizing enterocolitis
1. S/S: vomiting, abd. distention, and tenderness
2. Prematurity, congenital heart diseases more common
8. Peptic ulcer disease
1. >10 yrs: Meds (ex. NSAIDs)/Stress
2. H.pylori less common
9. Ectopic pregnancy
1. Postmenarchal girls
2. S/S: abd. pain, amenorrhea, vaginal bleeding
