Referred Abdominal Pain

Abdominal pain is one of the most common and distressing presentations that pediatricians encounter. Up to 25% of school-age children report pain severe enough to interfere with their daily activity, requiring many to seek the assistance of their pediatrician. In approaching pain, the location, duration, onset, radiation, alleviating/exacerbating factors, and associated symptoms should all be considered. Abdominal pain is generally classified as visceral, somatoparietal, or referred. Pain may originate from intra-abdominal organs, surrounding structures, or areas outside the abdomen. Visceral pain receptors are located in the muscles and mucosa of organs and, therefore, sense an acute stretching of the structure’s wall experienced as a diffuse aching or cramping. Somatoparietal pain receptors are located in the peritoneum, muscle, and skin of the parietal region and are experienced as a sharp well-localized pain that may be alleviated in a position that relaxes the peritoneum or muscle. Referred abdominal pain occurs when the brain is unable to localize the source of discomfort due to nociceptive dorsal horn neurons receiving convergent inputs from different tissues. It is usually located in the cutaneous dermatome, sharing the same spinal cord level as the visceral inputs. This poses a diagnostic challenge because pain due to a gastrointestinal etiology may be experienced at a distant location; conversely, pain originating from a location outside the abdominal viscera may be experienced as abdominal pain. This In Brief reviews important concepts and etiologies of referred abdominal pain.

Four common diagnoses that each highlight a type of referred abdominal pain are explored further: abdominal migraine, pelvic inflammatory disease (PID), peptic ulcer disease (PUD), and diabetic ketoacidosis (DKA). The Table provides a summary …