[07.01] PED - Abdominal Pain in Children V2.pdf

Thorough history taking, physical examination, and being present using one's senses

What are the essential components required to evaluate abdominal pain in children who cannot clearly describe their symptoms?

Acute or chronic abdominal pain

What is the first fundamental question to ask when evaluating a child presenting with abdominal pain?

Acute medical problem or acute surgical problem

If a child presents with acute abdominal pain, what is the key diagnostic question to determine immediate management?

Disorders of Gut-Brain Interaction (DGBI) / Functional abdominal pain or organic pathology

If a child presents with chronic abdominal pain, what key distinction must be investigated?

Less than 14 days

What duration defines acute abdominal pain in children according to the lecture cutoff?

More than 14 days

What duration defines chronic or recurrent abdominal pain (RAP) in children according to the lecture cutoff?

Three months

What duration cutoff for chronic abdominal pain is cited by other literature sources such as Lukic et al.?

Acute surgical problem

What category of abdominal pain requires rushing the patient immediately to the operating room for a life-saving procedure?

Ruptured Meckel's diverticulum, ruptured colonic diverticulum, or inflamed/ruptured appendix

What are three surgical emergencies that can cause visceral rupture and peritonitis with board-like abdominal rigidity?

Acute medical problem

What category of acute abdominal pain includes conditions like acute ascending cholangitis or acute pancreatitis that may require urgent admission or ICU care but not immediate surgery?

Disorder of Gut-Brain Interaction (DGBI) or Functional Abdominal Pain

What term describes real chronic abdominal pain experienced by a patient in the absence of an identifiable organic or medical condition needing treatment?

Malingering

What term refers to intentionally lying about pain, which is explicitly distinct from functional abdominal pain?

At least one-third

What proportion of humans experience abdominal pain due to innate gut-brain interactions?

Impaired linear growth / Stunting

What unique physical red flag in children represents an irreversible consequence of undiagnosed gastrointestinal pathology?

Growth chart

What clinical tool should physicians evaluate and correlate with chronicity when a child presents with abdominal pain?

Age-specific communication gaps

What factor makes finding a specific cause of abdominal pain particularly challenging in younger children?

Necrotizing enterocolitis

When a neonate presents with acute abdominal pain, what condition is ruled in while appendicitis is ruled out due to age?

Ectopic pregnancy and HEADSSSS assessment

What condition and clinical assessment framework should be specifically considered when an adolescent female presents with lower abdominal pain?

Necrotizing enterocolitis, Hirschsprung disease, meconium ileus, intestinal atresia/stenosis, incarcerated hernia, volvulus, and trauma

What are seven differential diagnoses for abdominal pain in a neonate?

Infantile colic (<3 months), acute gastroenteritis, intussusception, trauma, incarcerated hernia, volvulus, urinary tract infection, constipation, esophageal reflux, hemolytic uremic syndrome, and Henoch-Schonlein purpura

What are eleven differential diagnoses for abdominal pain in a child under 2 years of age?

Acute gastroenteritis, urinary tract infection, appendicitis, trauma, constipation, pneumonia, inflammatory bowel disease, testicular torsion, esophageal reflux, and pharyngitis

What are ten differential diagnoses for abdominal pain in a school-aged child (2–13 years old)?

Acute gastroenteritis, urinary tract infection, appendicitis, trauma, constipation, inflammatory bowel disease, ectopic pregnancy, esophageal reflux, and ovarian torsion

What are nine differential diagnoses for abdominal pain in an adolescent?

Nociceptors

What specialized pain nerve endings collect peripheral stimuli, pass through the spinal cord, and relay signals to the brain for processing?

Vagus nerve and trigeminal nerve

Which two cranial nerves transmit sensory signals directly to the brain without passing through the spinal cord?

Lamaze breathing

What breathing technique is utilized during labor to help manage pain?

Enteric nervous system (ENS)

What neural network is known as the "second brain" because it can direct gut motility independently even when the central nervous system is transected?

Submucosal plexus and myenteric plexus

Which two intrinsic neural plexi of the enteric nervous system regulate gastrointestinal motility, secretory, and immune activities?

Gut-brain-microbiota axis

What bidirectional signaling pathway links luminal microorganisms in the gut with neural cells, neurotransmitters, and central pain perception?

Intraluminal dysbiosis

What microbial state within the gut lumen plays a role in altering pain perception and triggering intestinal disease?

Autonomic nervous system and enteric nervous system

Which neural pathways transmit visceral pain sensations from internal organs?

Somatic pain

What type of pain is characterized as very sharp, precise, and well-localized, typically originating from skin or parietal structures?

Dull, aching, diffuse, and poorly localized

What are the primary qualitative characteristics of visceral pain?

Epigastric region

Where is visceral pain felt when the painful stimuli originate from foregut structures such as the liver, pancreas, biliary tree, stomach, or upper bowel?

Umbilical or periumbilical region

Where is visceral pain felt when the painful stimuli originate from midgut structures such as the distal small bowel, cecum, appendix, or proximal colon?

Hypogastric or suprapubic region

Where is visceral pain felt when the painful stimuli originate from hindgut structures such as the distal large bowel, urinary tract, or pelvic organs?

Colicky visceral pain

What specific wave-like, crampy pain occurs when smooth muscle walls of hollow internal organs contract intensely against an obstruction, irritation, or stretching?

Crescendo-decrescendo wave pattern

What physical pattern describes colicky pain as it builds to an intense peak and then eases before returning?

Sweating, nausea, vomiting, or restlessness

What four systemic symptoms frequently accompany severe colicky visceral pain?

Biliary colic

What condition causes severe right upper quadrant abdominal pain radiating to the right shoulder due to a gallstone blocking the bile duct or gallbladder outlet?

Renal colic (ureteral colic)

What condition causes intense, wave-like flank and lower abdominal pain radiating to the groin due to a stone passing through the ureter?

Intestinal colic

What condition produces crampy central abdominal waves accompanied by bloating or vomiting due to partial or complete bowel obstruction?

Dysmenorrhea

What condition causes wave-like lower abdominal or pelvic pain from uterine muscle contractions shedding the endometrial lining?

Somatic sensory / afferent nerves

Which fast-conducting nerve fibers transmit intense, precise, and well-localized pain signals directly to the brain?

Parietal peritoneum or abdominal wall

What somatic structure must come into contact with an inflamed viscus to transition pain from diffuse visceral to localized somatic pain?

Transmural inflammation touching the parietal peritoneum

What pathological transition causes appendicitis pain to shift from vague periumbilical discomfort to sharp point tenderness in the right lower quadrant?

Peritonitis

What intra-abdominal condition presents with generalized abdominal pain, board-like rigidity, involuntary guarding, rebound tenderness, and cutaneous hyperesthesia?

Point tenderness

What physical examination finding serves as a critical red flag indicating localized peritoneal inflammation or suppurative appendicitis?

Referred pain

What term describes extraintestinal pain perceived in the abdomen due to shared central projections within sensory pathways?

Lower basal pneumonia

What extra-abdominal pulmonary infection can cause referred epigastric abdominal pain by irritating the diaphragm?

Abdominal wall pain

What non-gastrointestinal type of pain originates from the skin, muscle, or subcutaneous tissue of the abdominal wall rather than internal viscera?

Nerve entrapment

What is one of the most common causes of abdominal wall pain in adults, most frequently located at the lateral border of the rectus muscle?

Costochondritis

What musculoskeletal condition produces pinpoint tenderness between the ribs that is reproduced by direct palpation of the rib margins?

Slipped rib syndrome

What abdominal wall condition can mimic hepatobiliary, splenic, pancreatic, esophageal, or gastric pathology?

Anterior cutaneous nerve entrapment syndrome (ACNES)

What specific syndrome causes severe, acute, recurrent, or chronic localized unilateral abdominal wall pain?

Point tenderness and vomiting

What two physical examination and clinical features serve as immediate red flags during the evaluation of acute abdominal pain?

Dehydration

Why is vomiting considered an essential red flag requiring further medical care, particularly in pediatric patients?

Organic pathology

What category of chronic abdominal pain includes conditions like Crohn's disease that require diagnostic workup such as endoscopy and biopsy for long-term medical management?

Age less than 5 years old

What age threshold serves as an independent red flag for an organic cause of pediatric abdominal pain?

Fever greater than 39.4°C

What temperature finding suggests conditions like pneumonia, pyelonephritis, dysentery, or cholangitis rather than simple perforation?

Fat, feces, flatus, fluid, and fetus

What clinical concept, known as the 5 Fs, summarizes the differential causes of abdominal distention?

Nocturnal pain (pain waking the child from sleep) and unexplained weight loss

What two prominent red flags in a child with chronic abdominal pain strongly point toward an organic etiology such as Inflammatory Bowel Disease?

94%

What is the cumulative sensitivity of red flags such as weight loss, hematochezia, and anemia for detecting Crohn's disease in children?

Gastroesophageal reflux, esophagitis, gastritis, gastroduodenal ulcer, pancreatitis, gastric or small bowel volvulus, and cholelithiasis/biliary colic

What are seven differential diagnoses for abdominal pain located in the epigastric region?

Constipation, colon spasm or colitis, bladder disease, uterine conditions, and pelvic inflammatory disease

What are five differential diagnoses for abdominal pain located in the hypogastric region?

Hepatitis, cholecystitis, cholelithiasis/biliary colic, cholangitis, right lower lobe pneumonia, and kidney disease

What are six differential diagnoses for abdominal pain located in the right upper quadrant?

Splenic injury, left lower lobe pneumonia, and kidney disease

What are three differential diagnoses for abdominal pain located in the left upper quadrant?

Constipation, mesenteric adenitis, Crohn disease, appendicitis, intussusception, ovarian disease/torsion, ectopic pregnancy, testicular torsion, and hernia

What are nine differential diagnoses for abdominal pain located in the right lower quadrant?

Constipation, colon spasm or colitis, ovarian disease/torsion, ectopic pregnancy, testicular torsion, hernia, and sigmoid volvulus

What are seven differential diagnoses for abdominal pain located in the left lower quadrant?

Constipation, gastroenteritis, early appendicitis, pancreatitis, small bowel volvulus, and incarcerated umbilical hernia

What are six differential diagnoses for abdominal pain located in the periumbilical region?

Gastroenteritis, celiac disease, perforation, constipation, functional abdominal pain, streptococcal pharyngitis, inflammatory bowel disease, Henoch-Schonlein purpura, diabetic ketoacidosis, porphyria, sickle cell crisis, volvulus, abdominal migraine, cyclic vomiting syndrome, toxic ingestion, familial Mediterranean fever, angioneurotic edema, and venomous bites

What are eighteen differential diagnoses for diffuse abdominal pain?

Trauma, ischemic bowel disease, and allergic disease

What three conditions present with abdominal pain in varied or unpredictable locations?

Malrotation

What congenital anomaly features incomplete embryologic gut rotation and a narrow mesentery root that easily twists during peristalsis, risking short bowel syndrome?

Intussusception

What condition occurs in children under 2 years old without anatomical lead points (often triggered by viral lymphadenopathy), causing invagination, pain, distention, and waxing and waning consciousness?

Polyp or Meckel's diverticulum

What two anatomical lead points trigger intussusception in children older than 2 years of age?

Incarcerated hernia

What surgical condition presents as a painful, irreducible mass protruding through the abdominal wall due to strangulation?

Pancreatitis

What condition presents with acute epigastric/LUQ pain radiating to the back, characterized as constant, sharp, and boring, accompanied by emesis and tenderness?

Mechanical intestinal obstruction

What condition presents with acute or gradual periumbilical to lower abdominal pain, alternating cramping with painless periods, distension, obstipation, and increased bowel sounds?

Urolithiasis

What condition presents with acute, sudden unilateral back pain radiating to the groin, characterized as sharp, intermittent cramping accompanied by hematuria?

Urinary tract infection

What condition presents with acute back pain radiating to the bladder, characterized by CVA tenderness, dysuria, urinary frequency, and fever?

Pelvic inflammatory disease

What condition presents with acute pelvic or lower quadrant pain radiating to the upper thigh, accompanied by vaginal discharge, fever, and peritoneal signs?

Ruptured ectopic pregnancy

What condition presents with sudden, acute pelvic or lower quadrant pain described as sharp, intense, and localized, accompanied by vaginal bleeding and shock?

Motility disturbance, visceral hypersensitivity, altered mucosal/immune function, altered gut microbiota, and altered central nervous system processing

What five physiological mechanisms interact to produce Disorders of Gut-Brain Interaction (DGBI)?

Over 40%

What proportion of the global population (both adults and children) is affected by Disorders of Gut-Brain Interaction?

28.0%

What is the overall prevalence of pediatric Disorders of Gut-Brain Interaction according to 2026 data?

Defecation and anorectal disorders (20.2%)

What is the most common category of pediatric Disorders of Gut-Brain Interaction?

Abdominal pain disorders (4.4%)

What is the second most common category of pediatric Disorders of Gut-Brain Interaction?

Rome Criteria

What set of expert diagnostic guidelines allows physicians to make a positive diagnosis of DGBIs based on symptom patterns, frequency, and duration rather than by exclusion?

At least two symptoms

How many specific symptoms must a patient experience during >25% of bowel movements to meet the Rome V criteria for chronic constipation?

Straining, lumpy/hard stools (Bristol 1-2), incomplete evacuation, anorectal obstruction, manual maneuvers, and fewer than three spontaneous bowel movements per week

What are the six clinical criteria for chronic constipation under Rome V?

Fecal retention

What condition appears on abdominal radiograph as mottled and hardened densities throughout the colon, causing mild visceral pain during peristalsis?

Anorexia

What clinical symptom is considered a red flag even in ulcer disease, making physicians significantly more concerned if a child refuses to eat?

Evaluate alarm signals / red flags

What is the immediate next step in the clinical algorithm for chronic abdominal pain after completing a history and physical exam?

Treat for functional constipation

In a child with chronic abdominal pain and no alarm signals, what is the top-of-mind diagnosis if Rome criteria for defecation are met?

CBC, ESR, CMP, Celiac panel, Urinalysis, Stool O&P, and Faecal calprotectin

What seven initial screening laboratory tests are recommended for evaluating chronic abdominal pain when organic pathology is suspected?

Choledochocele / Choledochal cyst

What congenital biliary anomaly can remain asymptomatic in childhood but present with sudden pain and carry a risk of turning into cholangiocarcinoma around age 30?

CT scan and MRI

Which two advanced imaging modalities are explicitly excluded as routine screening tools for pediatric abdominal pain due to radiation or high cost?

Lactose-free diet

What dietary intervention is explicitly NOT recommended for pediatric functional abdominal pain unless lactose intolerance is objectively proven?

Food antigen elimination diet

What restrictive intervention is NOT recommended for pediatric DGBI unless a allergologist confirms a specific food allergy diagnosis?

Probiotics

What treatment option shows inconsistent data and scant evidence in pediatric FGIDs, though it may benefit some children with IBS?

Proton-pump inhibitors (PPIs)

What pharmacologic class might provide symptom benefit for pediatric patients presenting with functional dyspepsia?