How should the diagnosis of functional abdominal pain be addressed in the emergency department (ED)? The diagnosis of functional abdominal pain is usually evident following the completion of the history and physical examination. Failure to mention this diagnosis early or obtaining unnecessary studies to appease an anxious family may only result in the parents feeling …
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What is the most common cause of recurrent abdominal pain? Although numerous organic causes are possible, up to 30% of patients will have functional pain with diagnoses such as irritable bowel syndrome and abdominal migraines. In the functional abdominal pain syndrome, the pain is generally episodic, is periumbilical, rarely occurs during sleep, and rarely is …
How is an acute abdominal emergency managed The immediate management should begin with a careful assessment of the patient’s airway, breathing, and circulation, particularly in an unstable patient. Intravascular access should be obtained and fluid resuscitation initiated with IV normal saline (20 mL/kg). Laboratory studies, including a blood glucose level, may be sent with blood …
What is the management of children who ingest foreign bodies? Children commonly ingest FBs due to their natural curiosity and play. Most ingested FBs pass spontaneously if they move beyond the gastroesophageal junction, are less than 5 cm in length, and are not very sharp (sewing needles). Most sharp objects such as tacks, screws, and …
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Are there any other useful radiologic studies for children with abdominal pain? Ultrasound is an integral component of the workup for pyloric stenosis and for renal calculi and can be useful in evaluating the postpubertal female with possible ovarian or uterine disease, or the child with suspected appendicitis. The CT scan is useful for detecting …
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What abnormalities may appear on plain radiographs in children with abdominal pain? The plain film should be assessed for “bones, stones, masses, and gas.” An appendicolith is present in only about 5% to 15% of patients with appendicitis. Other findings in appendicitis may include sentinel loop, air-fluid levels, fecolith, mass in right lower quadrant, and …
What imaging modalities are commonly used in children to confirm or rule out intussusception? Plain radiographs lack sensitivity and many false-negative results occur, so normal plain films should not exclude the diagnosis of intussusception. Later in the disease, up to 60% may show absence of air in the right upper and lower quadrants and evidence of …