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Abdominal Pain

Abdominal Pain is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • Abdominal pain is a subjective symptom that can originate from any intra-abdominal organ but also be secondary to nonabdominal sources (e.g., peridiaphragmatic conditions [e.g., pneumonia], referred pain, systemic infection [e.g., strep A or viral pharyngitis], depression).
  • Acute abdominal pain is often due to benign and self-limited etiologies but may also be due to potentially life-threatening conditions.
  • Chronic abdominal pain, defined as present >2 months, can either be of organic origin (anatomic, infectious, inflammatory, or metabolic) or, more frequently, part of a functional gastrointestinal disorder (FGID) based on specific diagnostic criteria (Rome IV).

Epidemiology

  • Abdominal pain is one of the most common complaints in pediatric patients.
  • Chronic abdominal pain represents 2–4% of general pediatrics office visits and >50% of pediatric gastroenterology visits and can be associated with significant morbidity. Thus, chronic pain also warrants careful consideration and management.

Pathophysiology

  • The nature of abdominal pain is multifactorial and may evolve in nature over time (i.e., in acute appendicitis, pain typically migrates from periumbilical to right lower quadrant).
  • Visceral pain (particularly from small intestine) is often poorly localized and is described as dull, diffuse, cramping, or burning. Visceral pain may be associated with autonomic reflex responses (diaphoresis, pallor, nausea, and/ or vomiting).
  • More localized, sharp somatoparietal pain typically indicates peritoneal involvement (appendicitis, cholecystitis).
  • Referred pain is related to the level of spinal cord entry of visceral afferent nerves (e.g., scapular pain in cholecystitis).

Etiology

  • Right upper quadrant
    • Cholelithiasis/cholecystitis
    • Hepatitis/perihepatitis
    • Nephrolithiasis
    • Ureteropelvic junction obstruction
    • Right lower lobe pneumonia
  • Epigastric area
    • Gastroesophageal reflux disease (GERD)
    • Esophagitis (GERD, eosinophilic)
    • Gastritis (NSAID, allergic, Helicobacter pylori, Crohn disease)
    • Functional dyspepsia
    • Ulcer disease (NSAID, H. pylori)
    • Pancreatitis
    • Cholecystitis
    • Gastric/small intestinal volvulus
  • Left upper quadrant
    • Splenic hematoma
    • Renal disease (see above)
    • Left lower lobe pneumonia
    • Constipation
  • Right lower quadrant
    • Appendicitis/perforation/psoas abscess
    • Mesenteric adenitis
    • Intussusception
    • Inflammatory bowel disease (IBD)
    • Infection (tuberculosis, Yersinia)
    • Ovarian/testicular torsion
    • Ectopic pregnancy
    • Inguinal hernia
  • Left lower quadrant
    • Constipation
    • Colitis (inflammatory/infectious)
    • Sigmoid volvulus
    • Genitourinary disease
  • Hypogastric area
    • Constipation
    • Colitis
    • Cystitis
    • Dysmenorrhea/uterine disease
    • Pelvic inflammatory disease
  • Periumbilical area
    • FGID
    • Constipation
    • Gastroenteritis (infectious/eosinophilic)
    • Pancreatitis
    • Gastric/small bowel volvulus
    • Appendicitis (early)
    • Incarcerated umbilical hernia
  • Diffuse
    • Constipation
    • FGID
    • Giardiasis
    • Carbohydrate malabsorption
    • Celiac disease
    • Streptococcal/viral pharyngitis
    • IBD
    • Allergic/eosinophilic gastroenteritis
    • Ischemic necrotizing enterocolitis (NEC)
    • Perforation/peritonitis
    • Malrotation with volvulus
    • Lead/iron poisoning/pica syndrome
    • Cyclic vomiting syndrome
    • Porphyria
    • Sickle cell crisis
    • Familial Mediterranean fever
    • Diabetic ketoacidosis
    • Henoch-Schönlein purpura (HSP)
    • Tumor
    • Trauma
    • Hemolytic uremic syndrome (HUS)

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Citation

Cabana, Michael D., editor. "Abdominal Pain." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617781/all/Abdominal_Pain.
Abdominal Pain. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617781/all/Abdominal_Pain. Accessed April 26, 2019.
Abdominal Pain. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617781/all/Abdominal_Pain
Abdominal Pain [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617781/all/Abdominal_Pain.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Abdominal Pain ID - 617781 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617781/all/Abdominal_Pain PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -