Types include hemorrhagic, ruptured, and ovulatory, and torsion of a cystĬough, shortness of breath, fever, tachypneaįlank tenderness, fever, nausea and vomiting Self-limiting, diagnosed on computed tomography 12 May be most common cause of abdominal pain 1Ĭampylobacter, Cryptosporidium, Escherichia coli, Salmonella, Shigella, rotavirusĬonstipation, severe diarrhea, bowel obstruction, perforation, sepsisĭelayed passage of meconium (more than 24 hours) in about 57% of cases 9Ĭhildhood prevalence of Crohn disease is 43 per 100,000 of ulcerative colitis, 28 per 100,000 10 When the appendix is not clearly visible on ultrasonography, computed tomography or magnetic resonance imaging can be used to confirm the diagnosis.Īnorexia, nausea, vomiting, headache, photophobia Appendicitis is the most common cause of acute abdominal pain requiring surgery, with a peak incidence during adolescence. Ultrasonography is the initial choice in children for the diagnosis of cholecystitis, pancreatitis, ovarian cyst, ovarian or testicular torsion, pelvic inflammatory disease, pregnancy-related pathology, and appendicitis. Abdominal radiography can be used to diagnose constipation or obstruction. Initial laboratory tests include complete blood count, erythrocyte sedimentation rate or C-reactive protein, urinalysis, and a pregnancy test. In female adolescents, clinicians should consider pelvic inflammatory disease, pregnancy, ruptured ovarian cysts, or ovarian torsion. In school-aged children, constipation and infectious causes of pain, such as gastroenteritis, colitis, respiratory infections, and urinary tract infections, are more common. In infants and toddlers, clinicians should consider congenital anomalies and other causes, including malrotation, hernias, Meckel diverticulum, or intussusception. The age of the child can help focus the differential diagnosis. Symptoms and signs that increase the likelihood of a surgical cause for pain include fever, bilious vomiting, bloody diarrhea, absent bowel sounds, voluntary guarding, rigidity, and rebound tenderness. Acute abdominal pain accounts for approximately 9% of childhood primary care office visits.
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