ACUTE Abdominal pain in children

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ACUTE Abdominal pain in children
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• mechanical and chemical stimuli

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mechanical signal

• sensitive is stretch
• cutting,
• tearing,
• crushing of viscera does not result in pain

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• pain may be classified into three categories
• visceral pain,
• somatoparietal pain,
• referred pain.

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• Visceral pain
• pain is usually dull and poorly localized in the
  midline epigastrium, periumbilical region, or
  lower midabdomen because abdominal organs
  transmit sensory afferents to both sides of the
  spinal cord

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• Secondary autonomic effects such as sweating,
  restlessness, nausea, vomiting, perspiration, and
  pallor often accompany visceral pain. The patient
  may move about in an effort to relieve the
  discomfort.

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Clinical Evaluation

• The most important part of the evaluation of a
  patient with abdominal pain is the history
• Chronology

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• . Pain that is sudden in onset, severe, and well
  localized is likely to be the result of an
  intra-abdominal catastrophe such as a perforated
  viscus, mesenteric infarction, or ruptured
  aneurysm. Such patients usually recall the exact
  moment of onset of their pain.

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• A second important temporal factor in abdominal
  pain is its progression. Pain in some disorders,
  such as gastroenteritis, is self-limited, whereas
  in others, such as appendicitis, it is
  progressive.

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• Location
• Intra-abdominal Causes of the Acute Abdomen

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CHILDREN

• URI/PNEUMONIA..
• GASTROENTRITIS
• METABOLIC (DIABET)
• APPANDICTIS
• HENOCH
• PEPTIC ULCER
• ANATOMICAL

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ANATOMIC BASIS OF PAIN
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APPROACH TO THE PATIENT WITH ACUTE ABDOMINAL
PAIN
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DIAGNOSE

• ACUTE
• CHRONIC

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ACUTE

• INTUSSUCEPTION
• APANDICITIS
• HERNIA
• INFECTION
• METABOLIC
• GASROINTESTINAL

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Pharmacologic Management of the Acute Abdomen

• 75 of emergency room physicians withhold
  analgesics pending evaluation of the patient by a
  surgeon.
• Patients with moderate to severe abdominal pain
  should receive analgesics during their
  evaluation.