This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- Robert D. Baker, MD, PhD*
- *Department of Pediatrics, Digestive Disease and Nutrition Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY
AUTHOR DISCLOSURE
Dr Baker has disclosed that he is a subinvestigator on PROKIDS (Pediatric Resource Organization for Kids with Inflammatory Intestinal Disease) and RISK (Pediatric Risk Stratification Study) grants. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- CRP:
- C-reactive protein
- CT:
- computed tomography
- DRE:
- digital rectal examination
- ERCP:
- endoscopic retrograde cholangiopancreatography
- GI:
- gastrointestinal
- HIDA:
- hydroxyiminodiacetic acid
- IV:
- intravenous
- MRI:
- magnetic resonance imaging
- TPN:
- total parenteral nutrition
- WBC:
- white blood cell
Education and Practice Gaps
Children frequently have acute abdominal pain. The physician must identify which child has a potentially catastrophic condition (<2%). Because the number of patients requiring immediate action is low, the physician can be lulled into a sense of safety. Infrequently, acute abdominal pain can be catastrophic, so the physician needs to be cognizant of conditions requiring action. Knowledge and judgment are key.
Objectives
After completing this article, readers should be able to:
Understand the causes and frequency of acute abdominal pain in childhood.
Develop a differential diagnosis based on age and symptoms.
Formulate a plan for evaluation and management of acute abdominal pain.
Choose the appropriate imaging study for various diagnoses.
Acute abdominal pain is a frequent and challenging problem facing pediatricians. The cause of acute abdominal pain can range from John Apley’s “little bellyacher” (1) to an emergency requiring immediate action. Assessing acute abdominal pain is a situation that requires excellent clinical acumen, an area where pediatricians should “prove their worth” by outperforming other primary caregivers. Making the correct diagnosis may earn the pediatrician accolades for saving a life (as in the case of intussusception or midgut volvulus) but may also not win friends (as when a mother is informed that the reason for her child’s excruciating pain is constipation). A mistaken diagnosis can have devastating results, either by not acting when action is called for or by performing unnecessary tests and procedures.
Because the differential diagnosis list for acute abdominal pain is long, a logical approach is to consider diagnoses by age group. Convenient age divisions …
Individual Login
Institutional Login
You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.
Log in through your institution
Pay Per Article - You may access this article (from the computer you are currently using) for 2 days for US$25.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.