Acute abdominal pain

How to approach children? How to take a history? How to take a history? –Basic: when, acute or insidious onset, duration, persistent or intermittent, location, character, other associated symptoms (fever, vomiting/diarrhea, cough, etc.), activity/appetite, stool passage, past history. –Children < 2y/o cannot answer your question. caregiver? Parents? –Chief complaint of an infant may be only intermittent/ or inconsolable crying. –Appearance: apprehensive or easy looking? Walking/running or bending posture

How to approach children? How to perform physical examination? How to perform physical examination? –Crying child/infant: PE of abdomen is impossible. – 可讓父母將小孩抱在懷裡，減少小孩的焦慮， 等比較不哭時，再去做 PE 。 –Peritoneal sign: tenderness, rebounding pain, 不讓人摸肚子, muscle guarding(+/-), pain while jumping

Causes of acute abdominal pain Medical: Medical: –Gastroenteritis- Pancreatitis –Constipation- Inflammatory bowel disease –Urinary tract infection- Henoch-Sch ö nlein purpura –Urolithiasis- Ulcer disease –Ovarian torsion and cyst- Meckel ’ s diverticulitis –Ectopic pregnancy –Pelvic inflammatory disease –Cholecystitis –Biliary colic

Causes of acute abdominal pain Surgical: Surgical: –Appendicitis –Intussusception –Malrotation with midgut volvulus –Incarcerated inguinal hernia –Testicular torsion –Hollow organ perforation