Abdominal pain in children

The vast majority of abdominal pain episodes in children are benign and self-limiting.

Persistent abdominal pain may signify an underlying process that requires intervention.

History and physical examination narrows the broad differential that can involve almost every organ system.

GI sources are the most common reason for abdominal pain, with infectious, congenital, and mechanical causes.

Differential diagnosis of acute abdominal pain in a toddler includes both gastrointestinal and non-gastrointestinal causes.

Constipation and gastroenteritis are both common and account for a substantial number of cases of abdominal pain in children.

Constipation in childhood is typically characterized by infrequent bowel movements, large stools, and difficult or painful defecation.

Appendicitis develops when the appendiceal lumen becomes obstructed by stool, barium, food, or parasites, and is rare in infants.

If left untreated progresses to ischemia, necrosis, and eventually perforation.

Perforation rate varies from 15.5% to 47%.

Gastroenteritis may be acute or chronic and be caused by viral, bacterial, or parasitic GI infections.

Eosinophilic gastroenteritis can result in significant abdominal pain.

Although abdominal pain often localizes to the G.I. tract, extra intestinal organ pathology including ovarian or testicular torsion, nephrolithiasis, cystitis, abdominal migraine, diabetic ketoacidosis, and streptococcal pharyngitis must be considered.

Hemolytic uremic syndrome, characterized by microangiopathic hemolytic anemia, thrombocytopenia, and nephropathy, can occur as a complication of gastroenteritis caused by toxin-producing Escherichia coli.

Abdominal pain is a common presenting symptom in intussusception, when a proximal segment of the intestine telescopes into the lumen of an immediately distal segment.

Intussusception is most commonly seen in infants between 3 and 18 months of age.

Probably the most common cause of intestinal obstruction in infants and children between 3 months and 6 years of age.

Intussusception is the second most common cause of acute abdomen in this age group.

Intussusception occurs most commonly in the ileocecal area.

In children less than 2 years of age intussusception are most likely caused by mesenteric lymphadenopathy secondary to an associated illness.

Mesenteric lymphadenopathy is still the most likely cause of Intussusception in older children, but other etiologies should be considered.

Children 6 years or older with jejunojejunal or ileoileal intussusception should be evaluated for a malignancy.

Ileoileal intussusception may seen with Henoch-Schonlein purpura.

Meckel diverticulum related symptomatic patients present before the age of 2 years, and intestinal obstruction is a known complication that may be observed in as many as 40% such patients.

Mesenteric adenitis, or inflammation of the mesenteric lymph nodes may be acute or chronic.

Mesenteric adenitis is often mistaken for other intraabdominal diagnoses, such as appendicitis.

Intestinal obstruction of the small or large bowel obstruction can occur at any age.

The etiology of intestinal obstruction can be congenital or acquired, with congenital causes include atresias of the duodenum or jejunoileum, or stenosis, which present in the newborn period.

Colonic atresia is an extremely rare cause of complete obstruction in children.

Acquired causes of intestinal obstruction can occur at any age and include small bowel adhesions, incarcerated or strangulated hernias, or tumors.

Omental cysts, are a rare cause of an intestinal obstruction.

Meconium ileus is an important cause of intestinal obstruction in the neonatal period.

In patients with cystic fibrosis a distal small bowel obstruction caused by impacted bowel contents that typically occurs in adolescents and adults with cystic fibrosis.

Volvulus can occur in any age group, but is most common in children less than 1 year old.

60% of children with volvulous present before 1 month of age.

Midgut volvulus is the most common type.

Intestinal malrotation refers to the spectrum of anatomic alterations that result from incomplete rotation of the gut during embryonic development.

Volvulus of the small bowel and part of the colon can occur only when malrotation exists.

Necrotizing enterocolitis is disease primarily of premature infants, particularly those weighing less than 1500 g.

Gastric and duodenal ulcers are uncommon among the pediatric population .

Inflammatory bowel disease may be a cause of abdominal pain in children and includes ulcerative colitis (UC) and Crohn disease (CD).

UC is uncommon in people younger than 10 years old.

Biliary dyskinesia is an increasing diagnosed.

Acute pancreatitis is uncommon in children,

Etiologies of pancreatitis in children include biliary stones, or alcohol, choledochal cyst, bile duct strictures, malignancies, parasitic diseases, trauma, drug induced by corticosteroids, estrogens, azathioprine, aspariginase, chlorothiazide, valproic acid, tetracycline, end-stage renal disease, aminoaciduria, hyperlipidemia, hypercalcemia, porphyria, inflammatory processes, including mumps, ulcerative colitis, infectious mononucleosis, cystic fibrosis, polyarteritis nodosa, systemic lupus erythematosus another collagen vascular diseases.

Occult abdominal trauma must be considered in abdominal pain.

Urinary tract infection may cause abdominal pain and may arise along any part of the urinary tract.

Painful menstruation can affect females of reproductive age.

Pelvic inflammatory disease (PID) may cause abdominal pain in adolescence, and miscarriage and ectopic pregnancy should be a considered in any female of reproductive age presenting with lower abdominal pain, amenorrhea, and vaginal bleeding.

Ectopic pregnancy in adolescence is a possibility.

Respiratory illnesses such as pneumonia or empyema may present as abdominal pain in the pediatric population.

Functional abdominal pain typically affects children between 5 and 14 years of age.

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