ACUTE Abdominal pain in children
• mechanical and chemical stimuli
mechanical signal
• • • • sensitive is stretch cutting, tearing, crushing of viscera does not result in pain
• pain may be classified into three categories: • visceral pain, • somatoparietal pain, • referred pain.
• 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
• 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.
Clinical Evaluation
• The most important part of the evaluation of a patient with abdominal pain is the history • Chronology
• . 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.
• 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.
• Location • Intra-abdominal Causes of the Acute Abdomen
CHILDREN
• • • • • • • URI/PNEUMONIA….. GASTROENTRITIS METABOLIC (DIABET) APPANDICTIS HENOCH PEPTIC ULCER ANATOMICAL
ANATOMIC BASIS OF PAIN
APPROACH TO THE PATIENT WITH ACUTE ABDOMINAL PAIN
DIAGNOSE
• ACUTE
• CHRONIC
ACUTE
INTUSSUCEPTION APANDICITIS HERNIA INFECTION METABOLIC GASROINTESTINAL
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.