Abdominal Pain
Diagnosis is dependent on age although there is some overlap. Remember that younger children and those with disabilities present with vague or non-specific symptoms.
Sepsis can present as abdominal pain in all ages.
Diagnoses in bold are surgical emergencies.
- Hirschsprungs
- Volvulus
- Incarcerated hernia
- Intussusception
- UTI
- Meckel’s diverticulum
- Sepsis
- Colic
- GORD
- CMPI
Diagnoses in bold are surgical emergencies.
- Appendicitis
- Gastroenteritis
- Intussusception
- UTI
- Volvulus
- Constipation
- Pneumonia
- Pharyngitis
- Sickle cell crisis
- Sepsis
Diagnoses in bold are surgical emergencies.
- Appendicitis
- DKA
- Gastroenteritis
- HSP
- Mesenteric adenitis
- Migraine
- UTI
- Volvulus
- Sickle cell crisis
- Inflammatory bowel disease
- Constipation
- Ovarian pathology
- Testicular torsion
- Viral illness
- Pneumonia
- Pharyngitis
- Sepsis
- Trauma
- Functional
Diagnoses in bold are surgical emergencies.
- Appendicitis
- DKA
- Cholecystitis
- Gastroenteritis
- Inflammatory bowel disease
- UTI
- Pancreatitis
- Ovarian cyst/torsion
- Mittelschmerz
- Ectopic pregnancy
- PID
- Testicular torsion
- Renal stones
- Viral illness
- Sepsis
- Trauma
- Functional
- Poisoning (Paracetamol)
- Hydration status
- Abdominal examination
- Focal vs generalized
- Rebound, Guarding or rigidity
- Distension, masses, faeces, bowel sounds
- Hernial orifices
- Respiratory examination
- ?cough, fever
| Diagnosis | Syptoms and signs |
|---|---|
| Appendicitis | Migrating pain, RIF pain, anorexia, fever, pain on cough/percussion/hopping, nausea and vomiting |
| Intussusception | Peak age 6-12 months, severe intermittent pain, pallor and lethargy common, red currant jelly stools (late sign), epigastric or central mass, AXR show signs of bowel obstruction with less gas in the right colon |
| Colic | 4-6 weeks, healthy baby with inconsolable crying, pulling up knees and flatus |
| Testicular torsion | Sudden onset, swollen tender testis, Prehn’s sign negative |
| Midgut volvulus | Newborn period but can occur in later, predisposing factors include malrotation and abnormal mesentery, bilious vomiting and abdominal distension |
| Mesenteric adenitis | Central/RIF pain, lymphadenitis preceding illness, fever, malaise, diarrhoea, voluntary guarding, no rebound tenderness |
Management
After assessing and attention to A B C
Establish intravenous access
- Consider number of lines and size needed
- Measure electrolytes and blood sugar if the patient appears dehydrated
- Blood cultures if potentially septic
Fluid resuscitation may be required
- Initial bolus 20ml/kg normal saline (10ml/kg in neonates, cardiac or patients with raised intracranial pressure)
- Shocked children can require huge volumes due to third spacing in gut
Investigations
- Not all children need investigation
- Urine dipstick or urgent microscopy dependent on age
- Bloods
- U&Es +/- LFTs
- Amylase in pancreatitis
- Blood sugar in DKA
- Gas
- Pregnancy test in teenage girls
- Imaging
- AXR for obstruction
- CXR pneumonia
- USS
Keep the patient fasted until surgical assessment if needed.
Ensure iv fluids running
- if likely to be delay until assessment
- in all young children and infants who are at risk of hypoglycemia
Provide adequate analgesia
- WHO 2 step ladder
- Consider analgesia for procedural pain
Place a nasogastric tube if bowel obstruction
- Consider replacing large losses ml for ml with 0.9% saline with 10mmol KCl per 500ml bag
Consider IV antibiotics
Documentation
- PEWS
- Strict input output
| Version: | 1 (adapted from HWPH version 2, 2014) |
|---|---|
| Guidelines Lead(s): | Dr S Bell, Consultant Paediatrician |
| Contributors: | Dr M Kumar, Dr S Bird, Dr J Aspel, Dr M Abu Bakar |
| Chief of Service: | Dr R Sanghavi |
| Version Implementation Date: | April 2020 |
| Reviewed: | J Aspel, S Bell, May 2024; R Sinnathuray June 2024 |
| Review Date: | January 2028 |
| Ratified at: | Paediatric Clinical Governance, January 2020, Noted June 2024 |
| Keywords: | Abdominal pain, pain, appendicitis, intussusception, mesenteric adenitis |
This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. This guideline is for use in Frimley Health Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.