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Pediatric Abdominal PainAka: Abdominal Pain in Children

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  1. See Also
    1. Pediatric Abdominal Pain Causes
    2. Acute Abdominal Pain
    3. Acute Pelvic Pain
  2. Types
    1. Acute Abdominal Pain
      1. Characteristics
        1. Less than 4-6 weeks (subacute less than 12 weeks)
        2. Single episode, self limited and treatable
        3. Episodic localized pain, sharp, stabbing
      2. Common Causes
        1. Urinary tract disease
        2. Peptic Ulcer Disease
        3. Inflammatory Bowel Disease
        4. Gastroesophageal Reflux Disease
    2. Chronic Abdominal Pain
      1. Characteristics
        1. Three episodes over 3 months
        2. Continuous, dull, vague and diffuse Abdominal Pain
        3. Recurrent, Associated with debilitation
      2. Common Causes
        1. Constipation
        2. Lactose intollerance
        3. Mittelschmerz
        4. Psychogenic (See Recurrent Abdominal Pain Syndrome)
          1. Secondary Gain
          2. Sexual abuse
          3. School Phobia
  3. Red Flags
    1. Vomiting
    2. Localized pain away from midline
    3. Altered bowel habits
    4. Growth disturbance
    5. Nocturnal episodes
    6. Radiation of pain
    7. Incontinence
    8. Systemic symptoms
    9. Family History
      1. Peptic Ulcer Disease
      2. Inflammatory Bowel Disease
  4. History of Abdominal Pain
    1. Timing
      1. Onset of Abdominal Pain
      2. Frequency, Duration and time of day
    2. Location and radiation of Abdominal Pain
    3. Intensity and character
    4. Food associations
      1. Milk or cheese
      2. Spicy food
      3. Caffeinated soda, tea
    5. Exacerbating ammd relieving features
    6. Associated symptoms
      1. Fatigue
      2. Syncope
      3. Headache
    7. Vomiting (before or after pain?)
    8. Change in stool consistency or frquency
    9. Relationships to activity and school
    10. Which days of the weeks
    11. Attempted therapies
  5. Review of systems
    1. Genitourinary and gynecological symptoms
    2. Respiratory symptoms
    3. CNS symptoms
    4. Musculoskeletal symptoms
  6. Past Medical History
    1. Surgical history
    2. Medications
    3. Major illnesses or hospitalizations
  7. Family History
    1. Ethnic Background
    2. Migraine Headache
    3. Seizure Disorder
    4. Gastroesophageal Reflux disease (GERD)
    5. Peptic Ulcer Disease (PUD)
    6. Inflammatory Bowel Disease (IBD)
    7. Irritable Bowel Syndrome (IBS)
    8. Pancreatitis
    9. Hepatitis
  8. Social History
    1. HEADSS
      1. Home
      2. Education
      3. Activities
      4. Drug Use
      5. Suicidal Ideation
      6. Sexual activity
    2. Death
    3. Divorce
    4. Serious illness
    5. Care providers
    6. Siblings
  9. Physical Exam
    1. Perform in comfortable, non-threatening environment
    2. Growth
    3. Development
    4. Appearance
    5. Vital signs
    6. Comprehensive exam
    7. Abdominal exam
      1. Test rebound as "Jump on and off table"
      2. Avoid removing hand rapidly (loses patient trust)
    8. Rectal Exam necessary
  10. Labs
    1. Screening
      1. Complete Blood Count
      2. Erythrocyte Sedimentation Rate
      3. Urinalysis
      4. Urine Pregnancy Test (Urine HCG) when appropriate
      5. Liver Function Tests
      6. Amylase
      7. Lipase
    2. Consider additional testing
      1. Helicobacter Pylori titer
      2. Ova and Parasites (e.g. Giardia)
      3. Hepatitis Serologies (A,B,C)
      4. Lead Ingestion
  11. Radiology
    1. Flat and Upright abdominal XRay (KUB)
    2. Consider
      1. Barium Enema
      2. RUQ Ultrasound
      3. Pelvic Ultrasound
      4. Abdominal CT
    3. Skeletal Survey (assess physical abuse)
    4. Upper GI with small bowel follow through
    5. Upper endoscopy (EGD)
    6. Colonoscopy

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