Table of Contents
Page created on February 14, 2022. Not updated since.
Evaluation of abdominal pain
In most cases abdominal pain is benign and self-limiting, but it’s important to identify and treat life-threatening causes, like appendicitis, volvulus, testicular torsion, strangulated inguinal hernia, etc.
Routine laboratory tests for acute abdominal pain include CBC, inflammatory markers, glucose, electrolyte, and kidney, liver, and pancreas function tests. Urine analysis is also routinely performed, with hCG if indicated.
A simple x-ray can show problems like bowel obstruction, perforation, and constipation. Ultrasound can show intussusception and appendicitis. Upper GI contrast study is useful to show obstruction/volvulus. CT may be used in some cases.
Differential diagnosis of acute abdominal pain in neonates
| Type of disorder | Etiology | Typical features |
| Surgical disorders | Incarcerated hernia | Palpable inguinal hernia, discoloured hernial sac, male patient, right side |
| Ileus (due to previous abdominal surgery or malrotation/volvulus) | Lower abdomen, alternation between pain and painless periods, bilious vomit, increased/decreased bowel sounds | |
| Hirschsprung disease | No passage of meconium, distended abdomen | |
| Necrotising enterocolitis | Sudden deterioration, distended and shiny abdomen, bloody diarrhoea, bilious vomiting | |
| Non-surgical disorders | Viral infection (URTI, etc.) | Cold symptoms |
| Constipation | Hard stool or no bowel movement | |
| Colic | Paroxysmal abdominal pain in otherwise healthy infant | |
| Gastroenteritis | Known sick contact, recent travel, diarrhoea, vomiting, fever, dehydration |
Differential diagnosis of acute abdominal pain in younger children
| Type of disorder | Etiology | Typical features |
| Surgical disorders | Acute appendicitis | Anorexia, vomiting, pain initially central but later localising to the McBurney point, fever, pain is worsened by movement |
| Intussusception | Child <3 years, cramping with painless periods, currant jelly stool, abdominal mass | |
| Trauma | Bruising, history of trauma, suspicious story from parents | |
| Incarcerated hernia | Palpable inguinal hernia, discoloured hernial sac, male patient, right side | |
| Testicular torsion | Postpubertal patient, painful testis, pain in groin | |
| Ileus (due to previous abdominal surgery or malrotation/volvulus) | Lower abdomen, alternation between pain and painless periods, bilious vomit, increased/decreased bowel sounds | |
| Non-surgical disorders | Viral infection (URTI, etc.) | Common cold symptoms |
| Constipation | Hard stool or no bowel movement | |
| Diabetic ketoacidosis | Fruity odour, known diabetes, slow onset, altered mental status, polyuria, polydipsia | |
| Gastroenteritis | Known sick contact, recent travel, diarrhoea, vomiting, fever, dehydration | |
| Mesenteric adenitis (due to viral URTI or idiopathic) | Similar as appendicitis, but normal appendix on imaging and enlarged mesenteric lymph nodes | |
| Urinary tract infection | Urinary symptoms, pain in lower abdomen | |
| Henoch-Schönlein purpura | Purpuric rash on butt and extensor surfaces, spares the trunk. Arthritis | |
| Sickle cell crisis | African or Mediterranean ethnicity, jaundice | |
| Lower lobe pneumonia | Fever, coughing |
Differential diagnosis of acute abdominal pain in older children/adolescents
| Type of disorder | Etiology | Typical features |
| Surgical disorders | Acute appendicitis | Anorexia, vomiting, pain initially central but later localising to the McBurney point, fever, pain is worsened by movement |
| Trauma | Bruising, history of trauma, suspicious story from parents | |
| Ileus | Lower abdomen, alternation between pain and painless periods, bilious vomit, increased/decreased bowel sounds, previous abdominal surgery | |
| Ectopic pregnancy | Sexually active female, positive pregnancy test | |
| Testicular torsion | Postpubertal patient, painful testis, pain in groin | |
| Pancreatitis | Epigastric/hypogastric belt-like pain, tenderness, vomiting | |
| Nephrolithiasis | Pain in back and groin, severe and colicky, haematuria | |
| Cholelithiasis/cholecystitis | Jaundice, vomiting. Right upper quadrant. | |
| Non-surgical disorders | Viral infection (URTI, etc.) | Common cold symptoms |
| Constipation | Hard stool or no bowel movement | |
| Diabetic ketoacidosis | Fruity odour, known diabetes, slow onset, altered mental status, polyuria, polydipsia | |
| Gastroenteritis | Known sick contact, recent travel, diarrhoea, vomiting, fever, dehydration | |
| Mesenteric adenitis (due to viral URTI or idiopathic) | Similar as appendicitis, but normal appendix on imaging and enlarged mesenteric lymph nodes | |
| Urinary tract infection | Urinary symptoms, pain in lower abdomen | |
| Sickle cell crisis | African or Mediterranean ethnicity, jaundice | |
| Lower lobe pneumonia | Fever, coughing |
Differential diagnosis of chronic/recurrent abdominal pain
| Type of disorder | Etiology | Typical features |
| Functional abdominal pain disorders (most cases) | Common for all functional disorders | Vague pain, poorly localised, resolves spontaneously, family history, triggered or exacerbated by stress |
| Irritable bowel syndrome | Altered bowel habits | |
| Abdominal migraine | Paroxysms of intense acute pain lasting >1 hour | |
| Functional dyspepsia | Postprandial fullness or early satiety, bloating, nausea, epigastric pain | |
| Organic disorders | Inflammatory bowel disease | Dull, crampy pain, fever, weight loss, haematochezia. Lower right quadrant |
| Lactose intolerance | Crampy pain, diarrhoea, occurs after milk consumption | |
| Coeliac disease | Crampy pain, weight loss, anorexia | |
| Peptic ulcer/gastritis | Pain wakes them up at night, relieved by eating, epigastric | |
| Dysmenorrhoea | Occurs during menstruation | |
| Pelvic inflammatory disease | Sexually active |