This document discusses abdominal pain in pediatric patients. It separates causes into acute vs chronic and organic vs functional. Common acute organic causes include malrotation, intussusception, appendicitis, mesenteric lymphadenitis, and obstructive lesions. Chronic organic causes include IBD, hepatitis, pancreatitis, and urolithiasis. Functional abdominal pain is more common in older children and lacks clear pathology. A thorough history, examination, and testing is needed to identify potential organic causes of abdominal pain in pediatric patients.

1. In pediatric age group

2. *It is common and challenging
compliant
•At least 20% of children will
consult a doctor for it by
the age of 15 years

3. ACUTE CHRONIC
* Child <2 years * Child >2 years
Surgical medical Surgical medical
-Malrotation
- volvulus
-Intussusceptions‘
- appenedcitis
--necrotising
- entrocoloitis
-Incarcerated inguinal
hernia
-GE
-- UTI
--Hepatitis
--Pneumonia
-- spontaneous
bacterial
peritonitis
-Appendicitis
- IO
- M diverticulum
- Peritonitis
- cholycycstits
-HSP
- Trauma
- incarcerated
ingunal hernia
-GE
-UTI
-Lead poisoning
-Non specific
abdominal pain
-IBD
-Hepatitis
-Mesenteric
lymphadenitis

5. ACUTECHRONIC
•The presence of at least 3 bouts of
pain
* severe enough to affect activity
* over a period of at least 3 months
Organic
Functional

6. CHRONIC ACUTE
* Child <2 years * Child >2 years
- colic
-Malabsorption
-Milk allergy
-- rotational defect
-Hirschsprung dis.
--Esophygitis
-Functional pain
- constipation
-Giardiasis
-Intra-abdominal
Abscess
-lead poisoning
-Pancreatitis
-Abdominal migraine
-Epilepsy
-Urolithiasis

7. Functional
-Abdominal pain without evidence of a pathologic
condition
-Usually between 4-14 years.
- the pain usually brief with pain free interval range
from days to weeks.
- site :over umbilicus, no radiation
- Lab. Ix. Not disclose any
abnormality
-

8. Organic
-Localized pain in non-preiumbilical region.
- referred pain.
-Pain awaken the child from sleep.
-Sudden onset of severe pain .
-High grade fever
-Dysuria
-Jaundice
-Anorexia /weight loss
-Reduce activity level
-Specific physical findings

9. •HISTORY : SOCRATES also systemic
symptoms :fever ,rash….
•Family Hx. : peptic ulcer , IBD
•EXAMINATION : general : clubbing
,arthritis ,rash
•Abdominal : distension ,tenderness,
organomegaly , bowel sounds and bruit

10. •ORGANIC CAUSES should be excluded
• patient with functional abdominal pain don’t
need any medication
•Hospitalization and drug therapy may reinforce
such pain behavior
•Therapy for : helminthiasis , protozoal infection
, H pylori and acid peptic disease is not useful
• severe acute pain may be relieved by
anticholinergics

11.  parasitic infestation :
 Giardia lamblia , Entameba histolytica
 PAIN MAY RECUR
even after ttt of infestation

12.  Acute appendicitis : classical triad of Rt lower
abdominal pain , fever , vomiting does not occur in all
cases
 Retrocecal type : is difficult to be diagnosed
( diarrhea and colicky abdominal pain ) is only the
symptom in these patients
DX. X-ray , US , CT scan also useful

13.  Acute mesenteric lymphadenitis
 C/F resemble acute appendicitis
 Hx. Reveal preceding resp. or enteric disease due to
the infxn with YERSINIA pseduotuberculosis
or YERSINIA enterocolitica
Area of tenderness in
mesenteric lymphadenitis
shifts when the patient is
rolled from site to site

14.  obstructive lesion of the gut
Mid gut volvulus
Meckel`s diverticulum
SXS :
-Colicky abdominal pain
- distension
- vomiting
-Exaggerated bowel sound

15.  Intussusception

16.  Peptic ulcer :
 Its believed to be infrequent I
n children
 Acute gastric ulceration : aspirin
,steroid ,potassium chloride ,toxins ,stress ( burns for
ex.)
 Zollinger Ellison $
 gstric > duedenal ( older age >9)
 Ttt:
- Antacids , anticholinergics
- H2 receptor blocker , PPI
- H. PYLORI : amoxicillin , clarithromycin, omprazole for
1-2 weeks

17.  GI allergy : diarrhea, N&V , colicky abdominal pain
 3 factors contribute to allergy development :
- Genetic – allergen exposure – contributory factors
Amebic liver abcess SXS : fever, loss of appetite ,Rt upper
abdominal pain .
Liver :tender ,enlarged , jaundice
is minimal or abcent
Ttt : metroniazole 20-50mg/kg/day
for 1 week
Passive congestion of liver : in CHF or pericarditis
Pain & tendress in Rt hypochondrium

18.  Acute pancreatitis
 * follow mumps , biliary tract disease , trauma ,drug
 Congenital anomilies anf generalized infection
Sand U amalyse are elevated
SXS :sudden sever pain ,vomiting , fever, extreme
prostration
Ttt: supportive
sx. Pancreatic abcess
&necrotic pancreatitis .

19. disorder of GU system :
GN,PN, urinary stone HN and ectopic kidney
Ddx in girl . Menstrul cycle ,salpingitis ovarian torsion
and hematocolpos
Pain out side the abdomen : basal pneumonia, RF,
endocarditis
Metabolic : DKA, lead poisoning