16. Abdominal pain in childhood. Diagnostic tests and differential diagnosis.

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

Leave a Reply

Inputting your name is optional. All comments are anonymous.