1. Acute Abdominal Pain in Children 萬芳家醫科 實習報告 組別 7 2003/07/31 – 2003/08/08 姓名 施富傑

2. Pain Visceral pain Parietal pain Referred pain

3. Visceral pain Visceral pain fibers: Bilateral,unmyelinated, enter the spinal cord at multiple area Visceral pain: dull, poor localized

4. Parietal pain Parietal pain fiber: myelinated, enter specific dorsal root ganglia Parietal pain: sharp, intense, discrete, localized

5. Referred pain Referred pain:the disease organ and remote area share the central pathways

6. Cause of Acute Abdominal Pain in Children Gastroinstestinal causes Live, spleen, and biliary tract disorders Genitourinary causes Metabolic disorders Hematologic disorders Drug and toxins Pulmonary causes

7. Clinical Evaluation History Physical examination Investigation Management

8. History Age Pain history Precipitating or Relieving factor Recent trauma Associated symptoms Gynecologic history Past history Family history

9. Physical examination General appearance Vital signs Abdominal examination Rectal and pelvic examination Associated signs

10. Investigation Blood cell count Urinalysis Plain-film abdominal radiographs Ultrasonography CT

11. Management Indications for surgical consultations in Children with Acute abdominal Pain Severe or increasing abdominal pain with progressive signs of deterioration Bile-stained or feculent Involuntary abdominal guarding/rigidity Rebound abdominal tenderness Marked abdominal distention with diffuse tympany Significant abdominal trauma Suspected surgical cause for the pain Abdominal pain without an obvious etiology