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1. ACUTE ABDOMINAL PAIN
Introduction
Acute abdominal pain is a common problem found in children due to various reasons. It is a
common GI complaint of children and adolescents. It affects children of all ages.
Definition
It is an abnormal condition in which there is sudden and abrupt onset of severe abdominal pain.
It requires immediate diagnosis and prompt management. Delay in initiation of management
leads to serious complication.
Epidemiology
The exact incidence and prevalence of abdominal pain affecting 9-15% of children. 13% of
middle school and 17% of high school children have weekly complaints of abdominal pain. It
affects males and females equally up to 9 years.
Types of abdominal pain
1) Visceral pain:
 Due to stretching of fibres innervating the walls of hollow or solid organs.
 It occurs early and poorly localized.
 It can be due to early ischemia or inflammation.
2) Parietal pain:
 Caused by irritation of parietal peritoneum fibres.
 Can be localized to a dermatome superficial to site of the painful stimulus.
3) Referred pain:
 Pain is felt at a site away from the pathological organ
 Pain is usually ipsilateral to the involved organ and is felt midline if pathology is midline.
Causes
There are multiple causes of acute abdominal pain in children. They can be classified as intra-
abdominal causes and extra abdominal causes. Intra-abdominal causes are either medical or
surgical.
A) Intra- abdominal causes:
1) Surgical causes;
 Congenital malformations(volvulus, malrotation)
 Intestinal obstruction
 Intussusception
 Appendicitis
 Peritonitis
2) Medical causes: These include intestinal infections and infestation (ameobiasis, giardiasis,
worm infestations)
 Urinary tract infection
 Gastroenteritis
 Mesenteric lymphadenitis
 Abdominal trauma (it can be intentional or non- intentional)
 Constipation

2.  Inflammatory bowel disease
 Hepatitis
 Pancreatitis
 Infantile colic
B) Extra-abdominal causes:
 Problems of lungs(pneumonia, pleurisy)
 Epilepsy
 Tonsillitis
 Diabetic ketoacidosis
Sign and symptoms
 Acute pain is usually localized and usually associated with one or more of the
following symptoms; fever, projectile vomiting, blood in stools, constipation,
diarrhoeal lump in abdomen and abdominal distension.
 Localized tenderness
Diagnostic evaluation
 History of illness with presenting features is diagnostic of the condition.
 Physical examination is to be done to assess the presence of dehydration, jaundice,
tenderness, abdominal distension, exaggerated or absent bowel sound.
 Rectal examination is to be performed to identify problems of the area.
 Investigations like X-ray abdomen, USG and laboratory studies of blood, urine and
stool are to be done to diagnose the exact cause.
 Barium study, endoscopy.
Treatment
Treatment is directed as the particular cause.
General management
 In younger patients probably due to volume depletion from vomiting, diarrhoea,
decreased oral intake treatment would be isotonic crystalloid.
 Antibiotics must be considered when treating suspected abdominal sepsis or
peritonitis. Medicines; cefoxitin, cefotetan ampicillin-sulbactum.
 Pain management.
 The child should not be sent home from school with abdominal pain; rather, the child
may be allowed to take a short break from class until abdominal cramping.
 Fibre supplements are useful to manage symptoms of irritable bowel syndrome.
 Severe and persistent pain may be relieved by anticholinergics.
Nursing management
Assessment
 Assess for symptoms of pain such as facial grimace, rubbing of neck or jaw,
reluctance to move.
 Assess for vital sign: tachycardia, increased blood pressure.

3.  Note onset, duration, location and pattern of pain.
 Assess for localized tenderness and gastro-intestinal symptoms.
Nursing diagnosis
 Acute pain related to hyperperistalsis, prolonged diarrhoea and tissue irritation
secondary to disease condition as evidenced by restlessness, pallor, elevated pulse,
respirations and blood pressure.
 Fluid volume deficit related to excessive losses through normal routes as evidenced by
vomiting, inadequate fluid intake and dehydration.
 Risk for infection related to surgical incision and wound drainage devices.
Intervention
 Provide comfort measures such as back rub, reposition and diversional activities.
 Observe and record abdominal distension, increased temperature and blood pressure.
 Provide comfortable bed and position to the child to promote comfort.
 Provide analgesic as indicated.
 Monitor intake and output
 Observe for excessively dry skin and mucous membrane, decreased skin turgor,
slowed capillary refill.
 Administer parenteral fluids as indicated.
Post- operative nursing management
 Encourage changing position at least every 2 to 3hourly.
 Dressing can be removed 3-4 days after operation or according to hospital policy.
 The drains are used to drain fluids accumulating after surgery, blood or pus.
 Inspection of drain’s contents and its amount.
 NPO until peristalsis returns, it is usually takes about 24 hours.
 Encourage patients to take high protein and vitamin C to enhance wound healing.
 Teach pain relieving measures such as relaxation techniques and position changes.
 Administer antibiotics as ordered.
References
 Adhikari.T. Essentials of pediatric nursing, first edition-2014, VidyartiPustakBhandar,
Bhotahity, Kathmandu, page no- 339-344.
 Kluwer .W ,Williams and Wilkins .L ,Essentials of pediatric nursing ,second edition
,page no 1551..
 https://www.ncbi.nlm.nih.gov
 https://nurseslabs.com