This document discusses paediatric acute abdominal pain, including common causes and approaches to assessment and management. It outlines various gastrointestinal, genitourinary, traumatic and systemic conditions that can cause abdominal pain in children. Key points emphasized are that a detailed history and physical exam are usually sufficient for diagnosis, repeated exams can be important, and to always consider non-accidental injury if findings are inconsistent. Common conditions discussed in more depth include appendicitis and testicular torsion.

1. Paediatric acute abdominal
pain
- Dr Santa Gurung, CT2
General Surgery

2. - One of the commonest presentation in children
- Encountered in GP, A&E, gastroenterology clinics, surgical clinics

3. Causes of abdominal pain
1. Trauma
2. Gastrointestinal
3. Hepatopancreatobiliary
4. Genitourinary
5. Hematological and lymphatic systems
6. Respiratory

4. Trauma
- Direct impact of the mechanical force
- Intra-abdominal injury resulting in bleed/hematoma, solid organ injury,
pancreatitis

5. gastrointestinal
- constipation
- Appendicitis
- Mesenteric adenitis
- Gastroenteritis
- IBD
- Intussussception
- Intestinal obstruction
- Meckel’s diverticulum
- Malrotation and volvulus
- PUD

6. HPB
- Hepatitis
- Biliary colic
- Acute cholecystitis
- Pancreatitis
- Pancreatic pseudocyst

7. Genitourinary
- UTI
- Testicular torsion
- Renal colic
- Pyelonephritis
- mittelschmerz(mid cycle pain)
- Ovarian cyst torsion

8. Hematological and lymphatic system
- Sickle cell crisis
- Splenic cyst

10. Assessment
- Most of the times, detailed history and physical examination leads to
diagnosis
- Active observations and repeated examinations can be vital
- Mother knows best !
- Always consider non accidental injury if things don’t fit together!

11. History
- Older children can give reliable history
- Usually younger children
- Doubtful timing and location of abdominal pain
- Consult the parents
- Characteristics of the pain ‘SOCRATES’

12. Examination
- Judicious use of analgesics is important
- Analgesics don’t mask signs
- Instead may help reveal findings with a more cooperative patient
- Body language
- active/ irritable / lethargic
- Full systemic examination

13. Investigations
- Routine bloods
- Urine dip
- Urine bHCG
- +/- XR
- USS abdomen +/- pelvis
- CT abdomen
- MRI abdomen
- Diagnostic laparoscopy

14. Common conditions
- Non specific abdominal pain
- Appendicitis : most common surgical cause
- Gastroenteritis : most common medical cause
- Testicular pain
- Testicular torsion
- Epididymitis
- Epididymo-orchitis
- Acute idiopathic scrotal edema
- Constipation

15. Appendicitis
- Inflammation of the appendix
- Pathogenesis
- Obstruction of the lumen -> build up of mucus and swells
- Increase in intraluminal pressure -> appendicular wall
- Thrombosis and occlusion of blood vessels, inflammatory process
- Pus may form within (suppuration)
- Stasis of lymph flow -> ischemia and necrosis
- Perforation -> peritonitis/ septicemia/ intra-abdominal abscess

16. Types
- Depending on severity
- Acute
- Acute inflammatory
- Acute suppurative
- Complicated
- Perforated
- Gangrenous
- Appendicular mass
- Depending on location
- Retrocaecal
- Pelvic
- Pre ileal
- Post ileal

17. - History and examination usually diagnostic
- Special signs
- Rovsing’s sign
- Psoas sign
- Obturator sign
- Blood, urine dip +/- bHCG
- Consider USS in females
- If parents aren’t happy, always admit for observations

18. Laboratory parameters
- Raised WCC
- If > 20, ? perforated appendicitis
- Raised CRP
- Significance of isolated hyperbilirubinemia
- ? perforated appendicitis

19. Management
- Medical
- Resuscitate accordingly
- Analgesia
- Indication for antibiotics
- When to start ?
- How long to continue ?
- Surgical
- Laparoscopic
- Open

20. Testicular torsion
- More common in adolescents
- CLINICAL DIAGNOSIS
- Time critical : ~ 6 hr window
- D/D
- Epididymitis
- Epididymo-orchitis
- Secondary to trauma
- AISE
- USS not diagnostic and not indicated
- To r/o testicular rupture/hematoma secondary to trauma
- Will need scrotal exploration for confirmation

21. Thank you …..