Abdominal pain in children: Difference between revisions

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==Overview==
==Overview==
Abdominal pain is a common presenting symptom in pediatrics primary care. Most of times it's due to benign causes without risk for complications, but severe abdominal pain maybe an alarming sign for abdominal pathology that requires surgical intervention.<ref name="Kamgaing ERogombe S2017">{{cite journal|last1=Kamgaing E|first1=Kuissi|last2=Rogombe S|first2=Minto o |last3=P|first3=Mowangue |last4=M|first4=Njiomo |last5=J|first5=Koko |last6=S|first6=Ategbo |title=Epidemiological Aspects of Abdominal Pain in Children at the El Rapha Polyclinic in Libreville - Gabon|journal=Clinical Pediatrics: Open Access|volume=02|issue=04|year=2017|issn=25720775|doi=10.4172/2572-0775.1000126}}</ref>
Abdominal pain in [[children]] is a common presenting [[symptom]] in [[pediatrics]] [[primary care]]. There's multiple [[causes]] of abdominal pain that require different types of investigations and treatment options.


==Historical Perspective==
==Historical Perspective==


*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*[[Celiac disease]] was first discovered by Dutch [[Pediatricians|pediatrician]]<nowiki/>s, in late 1940s<ref name="urlCELIAC DISEASE">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203336/ |title=CELIAC DISEASE |format= |work= |accessdate=}}</ref>.
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In late 1980s, the first classification and [[diagnostic criteria]] for [[functional gastrointestinal disorders]] was developed by a group of international experts were recruited by Professor Aldo Torsoli from Italy to develop Working Teams for the International [[Gastroenterology]] meeting in Rome 1988 to the goal was to answer difficult questions using a consensus methodology through the Delphi approach about a group of [[Gastrointestinal disorders|gastrointestinal disorder]]<nowiki/>s that had little scientific-based evidence to understand [[etiology]] [[pathophysiology]] and treatment at the time<ref name="urlWhat Is New in Rome IV">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383110/ |title=What Is New in Rome IV |format= |work= |accessdate=}}</ref>.
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
*In May of 2016, after Rome III had been in effect for a decade, Rome IV was released<ref name="urlUpdate on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/28374308/ |title=Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice - PubMed |format= |work= |accessdate=}}</ref>. It is a result of collective work by committees that included more than 100 leading functional GI experts<ref name="urlUpdate on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/28374308/ |title=Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice - PubMed |format= |work= |accessdate=}}</ref>.
 
==Classification==
==Classification==


*Abdominal pain in children may be classified according to age into two groups:<ref name="pmid20779127">{{cite journal| author=Short AR| title=ABDOMINAL PAIN IN CHILDREN. | journal=Br Med J | year= 1935 | volume= 1 | issue= 3883 | pages= 1157-9 | pmid=20779127 | doi=10.1136/bmj.1.3883.1157 | pmc=2460552 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20779127  }} </ref>
*Abdominal pain in [[children]] may be classified according to [[age]] into two groups:<ref name="pmid20779127">{{cite journal| author=Short AR| title=ABDOMINAL PAIN IN CHILDREN. | journal=Br Med J | year= 1935 | volume= 1 | issue= 3883 | pages= 1157-9 | pmid=20779127 | doi=10.1136/bmj.1.3883.1157 | pmc=2460552 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20779127  }} </ref>
**Abdominal pain in children below five years old. <br>
**Abdominal pain in [[children]] below five years old. <br>
**Abdominal pain in children above five years old. <br>
**Abdominal pain in [[children]] above five years old. <br>
*Other method for classification of abdominal pain can be according to the duration of the pain<ref name="pmid23575296">{{cite journal| author=Eizenga W, Gieteling MJ, Berger M, Geijer RM| title=[Summary of the NHG guideline 'Abdominal pain in children', the 100th NHG guideline]. | journal=Ned Tijdschr Geneeskd | year= 2013 | volume= 157 | issue= 15 | pages= A6191 | pmid=23575296 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23575296  }} </ref>:
*Other method for classification of abdominal pain can be according to the duration of the [[pain]]<ref name="pmid23575296">{{cite journal| author=Eizenga W, Gieteling MJ, Berger M, Geijer RM| title=[Summary of the NHG guideline 'Abdominal pain in children', the 100th NHG guideline]. | journal=Ned Tijdschr Geneeskd | year= 2013 | volume= 157 | issue= 15 | pages= A6191 | pmid=23575296 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23575296  }} </ref>:
**Acute Abdominal pain(less than 1 week).
**Acute Abdominal pain(less than 1 week).
**Chronic Abdominal pain(more than 1 week).
**Chronic Abdominal pain(more than 1 week).
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==Pathophysiology==
==Pathophysiology==


*The pathogenesis of abdominal pain is related to either insult to intra-abdominal structures or extra-abdominal structure. Also it can be due to injury to somatic structures that's overlay the abdominal wall <ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
*The [[pathogenesis]] of abdominal pain is related to either insult to intra-abdominal structures or extra-abdominal structure. Also it can be due to injury to somatic structures that's overlay the [[abdominal wall]] <ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
*On Summary the pathophysiology of abdominal pain maybe due to :
*On Summary the [[pathophysiology]] of abdominal pain maybe due to :
**Visceral Pain:
**Visceral Pain:
***Result when there's a damage to nerve within the abdomen.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Result when there's a damage to [[nerve]] within the [[abdomen]].<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Due to the fact that visceral nerves fibers that responsible for pain sensation are non-myelinated, the visceral pain is Vague, dull, poorly localized and slow on onset.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Due to the fact that visceral [[nerve fibers]] that responsible for [[pain]] sensation are non-myelinated, the visceral pain is Vague, dull, poorly localized and slow on onset.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Different types of stimuli including chemical, osmotic and even normal peristalses can stimulate these fibers.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Different types of stimuli including chemical, [[osmotic]] and even normal [[peristalsis]] can stimulate these fibers.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Visceral pain is always sensed when the threshold of intensity or duration is reached.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Visceral pain is always sensed when the threshold of intensity or duration is reached.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Mild stimuli may result in sensing non-painful or vaguely un-comfortable sensation, in contrast to powerful stimulation to visceral nerve fibers which causes pain.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Mild stimuli may result in sensing non-painful or vaguely un-comfortable sensation, in contrast to powerful stimulation to visceral [[nerve fibers]] which causes pain.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Example for pain caused due to over-sensation of visceral nerve fibers is functional abdominal pain.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
***Example for [[pain]] caused due to over-sensation of visceral [[nerve fibers]] is functional abdominal pain.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
**Somatic Pain:
**Somatic Pain:
***Due to insult to somatic structures(parietal peritoneum, fascia, muscles, and skin of the abdominal wall).<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
***Due to insult to somatic structures([[parietal peritoneum]], [[fascia]], [[muscles]], and [[skin]] of the [[abdominal wall]]).<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
***Somatic nerves fibres are myelinated that can rapidly transmit well localized painful stimuli<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
***Somatic [[nerve fibers]] are [[myelinated]] that can rapidly transmit well localized [[painful]] stimuli<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
***Visceral pain can progress to somatic pain when the insult from intra-abdominal structures progress to affect the somatic structures(for example parietal peritoneum)as happens in acute appendicitis which start as visceral pain after that it progress to somatic pain.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
***Visceral [[pain]] can progress to somatic [[pain]] when the insult from intra-abdominal structures progress to affect the somatic structures(for example [[parietal peritoneum]])as happens in [[acute appendicitis]] which start as visceral pain after that it progress to somatic pain.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
**Referred Pain:
**Referred Pain:
***Pain sensation that referred from other site on the body.<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
***[[Pain]] sensation that referred from other site on the [[body]].<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
***This occur due to stimulation of spinal cord somatic sensory cell bodies which activated by stimuli from  visceral afferent fibers, which located on the same level on the spinal cord)<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
***This occur due to stimulation of [[spinal cord]] somatic sensory cell bodies which activated by stimuli from  [[visceral afferent fibers]], which located on the same level on the [[spinal cord]]<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.


==Causes==
==Causes==
There is a wide range of causes for pediatric abdominal pain which maybe due to a disease in variety of systems. In general, differentiating between acute and chronic pain in children is not easy, Despite it's being benign conditions in most children presenting with abdominal pain but some serious conditions may be the cause of the abdominal pain. On the table below there's some systems and related diseases that can cause abdominal pain in children:<ref name="urlEvaluation of abdominal pain in children - Etiology | BMJ Best Practice US">{{cite web |url=https://bestpractice.bmj.com/topics/en-us/787/aetiology |title=Evaluation of abdominal pain in children - Etiology &#124; BMJ Best Practice US |format= |work= |accessdate=}}</ref>
There is a wide range of [[causes]] for [[pediatric]] abdominal pain which maybe due to a [[disease]] in variety of systems. In general, differentiating between acute and chronic pain in children is not easy, Despite it's being benign conditions in most [[children]] presenting with [[abdominal pain]] but some serious conditions may be the cause of the [[abdominal pain]]. On the table below there's some systems and related [[diseases]] that can cause abdominal pain in children:<ref name="urlEvaluation of abdominal pain in children - Etiology | BMJ Best Practice US">{{cite web |url=https://bestpractice.bmj.com/topics/en-us/787/aetiology |title=Evaluation of abdominal pain in children - Etiology &#124; BMJ Best Practice US |format= |work= |accessdate=}}</ref>
{| class="wikitable"
{| class="wikitable"
|+Causes of Abdominal pain In Children
|+Causes of Abdominal pain In Children
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|-
|-
|Gastrointestinal
|Gastrointestinal
|Appendicitis<ref name="pmid26015876">{{cite journal |vauthors=Marzuillo P, Germani C, Krauss BS, Barbi E |title=Appendicitis in children less than five years old: A challenge for the general practitioner |journal=World J Clin Pediatr |volume=4 |issue=2 |pages=19–24 |date=May 2015 |pmid=26015876 |pmc=4438437 |doi=10.5409/wjcp.v4.i2.19 |url=}}</ref>, Gastrointestinal reflux disease<ref name="pmid8820774">{{cite journal |vauthors=Moir CR |title=Abdominal pain in infants and children |journal=Mayo Clin Proc |volume=71 |issue=10 |pages=984–9, quiz 989 |date=October 1996 |pmid=8820774 |doi=10.1016/S0025-6196(11)63773-7 |url=}}</ref>, constipation <ref name="pmid8820774">{{cite journal |vauthors=Moir CR |title=Abdominal pain in infants and children |journal=Mayo Clin Proc |volume=71 |issue=10 |pages=984–9, quiz 989 |date=October 1996 |pmid=8820774 |doi=10.1016/S0025-6196(11)63773-7 |url=}}</ref>,irritable bowel syndrome<ref name="pmid29881232">{{cite journal |vauthors=Devanarayana NM, Rajindrajith S |title=Irritable bowel syndrome in children: Current knowledge, challenges and opportunities |journal=World J Gastroenterol |volume=24 |issue=21 |pages=2211–2235 |date=June 2018 |pmid=29881232 |pmc=5989237 |doi=10.3748/wjg.v24.i21.2211 |url=}}</ref>, celiac disease <ref name="pmid20301720">{{cite journal |vauthors=Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Mirzaa G, Amemiya A, Taylor AK, Lebwohl B, Snyder CL, Green PHR |title= |journal= |volume= |issue= |pages= |date= |pmid=20301720 |doi= |url=}}</ref>,Meckel's  divreticulum<ref name="pmid31294008">{{cite journal |vauthors=Keese D, Rolle U, Gfroerer S, Fiegel H |title=Symptomatic Meckel's Diverticulum in Pediatric Patients-Case Reports and Systematic Review of the Literature |journal=Front Pediatr |volume=7 |issue= |pages=267 |date=2019 |pmid=31294008 |pmc=6606722 |doi=10.3389/fped.2019.00267 |url=}}</ref>, Intussusception<ref name="pmid30806357">{{cite journal |vauthors=Simon NM, Joseph J, Philip RR, Sukumaran TU, Philip R |title=Intussusception: Single Center Experience of 10 Years |journal=Indian Pediatr |volume=56 |issue=1 |pages=29–32 |date=January 2019 |pmid=30806357 |doi= |url=}}</ref>, Volvulus<ref name="pmid28722866">{{cite journal |vauthors=Le CK, Nahirniak P, Anand S, Cooper W |title= |journal= |volume= |issue= |pages= |date= |pmid=28722866 |doi= |url=}}</ref>.functional dyspepsia (FD)<ref name="urlEpidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126982# |title=Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis |format= |work= |accessdate=}}</ref>, abdominal migraine (AM)<ref name="urlEpidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126982# |title=Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis |format= |work= |accessdate=}}</ref>, functional abdominal pain (FAP) and functional abdominal pain syndrome (FAPS)<ref name="urlEpidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126982# |title=Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis |format= |work= |accessdate=}}</ref>
|[[Appendicitis]]<ref name="pmid26015876">{{cite journal |vauthors=Marzuillo P, Germani C, Krauss BS, Barbi E |title=Appendicitis in children less than five years old: A challenge for the general practitioner |journal=World J Clin Pediatr |volume=4 |issue=2 |pages=19–24 |date=May 2015 |pmid=26015876 |pmc=4438437 |doi=10.5409/wjcp.v4.i2.19 |url=}}</ref>, [[Gastrointestinal reflux disease]]<ref name="pmid8820774">{{cite journal |vauthors=Moir CR |title=Abdominal pain in infants and children |journal=Mayo Clin Proc |volume=71 |issue=10 |pages=984–9, quiz 989 |date=October 1996 |pmid=8820774 |doi=10.1016/S0025-6196(11)63773-7 |url=}}</ref>, [[constipation]] <ref name="pmid8820774">{{cite journal |vauthors=Moir CR |title=Abdominal pain in infants and children |journal=Mayo Clin Proc |volume=71 |issue=10 |pages=984–9, quiz 989 |date=October 1996 |pmid=8820774 |doi=10.1016/S0025-6196(11)63773-7 |url=}}</ref>,[[irritable bowel syndrome]]<ref name="pmid29881232">{{cite journal |vauthors=Devanarayana NM, Rajindrajith S |title=Irritable bowel syndrome in children: Current knowledge, challenges and opportunities |journal=World J Gastroenterol |volume=24 |issue=21 |pages=2211–2235 |date=June 2018 |pmid=29881232 |pmc=5989237 |doi=10.3748/wjg.v24.i21.2211 |url=}}</ref>, [[celiac disease]] <ref name="pmid20301720">{{cite journal |vauthors=Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Mirzaa G, Amemiya A, Taylor AK, Lebwohl B, Snyder CL, Green PHR |title= |journal= |volume= |issue= |pages= |date= |pmid=20301720 |doi= |url=}}</ref>,[[Meckel's  diverticulum]]<ref name="pmid31294008">{{cite journal |vauthors=Keese D, Rolle U, Gfroerer S, Fiegel H |title=Symptomatic Meckel's Diverticulum in Pediatric Patients-Case Reports and Systematic Review of the Literature |journal=Front Pediatr |volume=7 |issue= |pages=267 |date=2019 |pmid=31294008 |pmc=6606722 |doi=10.3389/fped.2019.00267 |url=}}</ref>, [[Intussusception]]<ref name="pmid30806357">{{cite journal |vauthors=Simon NM, Joseph J, Philip RR, Sukumaran TU, Philip R |title=Intussusception: Single Center Experience of 10 Years |journal=Indian Pediatr |volume=56 |issue=1 |pages=29–32 |date=January 2019 |pmid=30806357 |doi= |url=}}</ref>, [[Volvulus]]<ref name="pmid28722866">{{cite journal |vauthors=Le CK, Nahirniak P, Anand S, Cooper W |title= |journal= |volume= |issue= |pages= |date= |pmid=28722866 |doi= |url=}}</ref>.[[functional dyspepsia]] (FD)<ref name="urlEpidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126982# |title=Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis |format= |work= |accessdate=}}</ref>, abdominal migraine (AM)<ref name="urlEpidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126982# |title=Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis |format= |work= |accessdate=}}</ref>, functional abdominal pain (FAP) and functional abdominal pain syndrome (FAPS)<ref name="urlEpidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126982# |title=Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis |format= |work= |accessdate=}}</ref>
|-
|-
|Genitourinary
|Genitourinary
|Nephrolithiasis<ref name="urlNephrolithiasis - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/25905296/ |title=Nephrolithiasis - PubMed |format= |work= |accessdate=}}</ref> , urinary tract infection<ref name="pmid31783012">{{cite journal |vauthors=Simões E Silva AC, Oliveira EA, Mak RH |title=Urinary tract infection in pediatrics: an overview |journal=J Pediatr (Rio J) |volume=96 Suppl 1 |issue= |pages=65–79 |date=2020 |pmid=31783012 |doi=10.1016/j.jped.2019.10.006 |url=}}</ref>.
|[[Nephrolithiasis]]<ref name="urlNephrolithiasis - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/25905296/ |title=Nephrolithiasis - PubMed |format= |work= |accessdate=}}</ref> , [[urinary tract infection]]<ref name="pmid31783012">{{cite journal |vauthors=Simões E Silva AC, Oliveira EA, Mak RH |title=Urinary tract infection in pediatrics: an overview |journal=J Pediatr (Rio J) |volume=96 Suppl 1 |issue= |pages=65–79 |date=2020 |pmid=31783012 |doi=10.1016/j.jped.2019.10.006 |url=}}</ref>.
|-
|-
|Infections
|Infections
|viral (mesenteric adenitis)<ref name="urlNon-specific abdominal pain during school term may be due to viral infections then - PubMed">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/10445940 |title=Non-specific abdominal pain during school term may be due to viral infections then - PubMed |format= |work= |accessdate=}}</ref>, gastroenteritits<ref name="pmid31194486">{{cite journal |vauthors= |title=Correction |journal=Am Fam Physician |volume=99 |issue=12 |pages=732 |date=June 2019 |pmid=31194486 |doi= |url=}}</ref>,Multisystem Inflammatory Syndrome in Children (MIS-C) caused by covid-19<ref name="pmid32891582">{{cite journal |vauthors=Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, Gupta A |title=Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation |journal=Paediatr Respir Rev |volume= |issue= |pages= |date=August 2020 |pmid=32891582 |pmc=7417920 |doi=10.1016/j.prrv.2020.08.001 |url=}}</ref>
|viral (mesenteric adenitis)<ref name="urlNon-specific abdominal pain during school term may be due to viral infections then - PubMed">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/10445940 |title=Non-specific abdominal pain during school term may be due to viral infections then - PubMed |format= |work= |accessdate=}}</ref>, [[gastroenteritis]]<ref name="pmid31194486">{{cite journal |vauthors= |title=Correction |journal=Am Fam Physician |volume=99 |issue=12 |pages=732 |date=June 2019 |pmid=31194486 |doi= |url=}}</ref>,Multisystem Inflammatory Syndrome in Children (MIS-C) caused by [[COVID-19|covid-19]]<ref name="pmid32891582">{{cite journal |vauthors=Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, Gupta A |title=Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation |journal=Paediatr Respir Rev |volume= |issue= |pages= |date=August 2020 |pmid=32891582 |pmc=7417920 |doi=10.1016/j.prrv.2020.08.001 |url=}}</ref>


|-
|-
|Gynecologic
|Gynecologic
|Dysmenorrhea.<ref name="pmid21747105">{{cite journal |vauthors=Gieteling MJ, Lisman-van Leeuwen Y, van der Wouden JC, Schellevis FG, Berger MY |title=Childhood nonspecific abdominal pain in family practice: incidence, associated factors, and management |journal=Ann Fam Med |volume=9 |issue=4 |pages=337–43 |date=2011 |pmid=21747105 |pmc=3133581 |doi=10.1370/afm.1268 |url=}}</ref>
|[[Dysmenorrhea]].<ref name="pmid21747105">{{cite journal |vauthors=Gieteling MJ, Lisman-van Leeuwen Y, van der Wouden JC, Schellevis FG, Berger MY |title=Childhood nonspecific abdominal pain in family practice: incidence, associated factors, and management |journal=Ann Fam Med |volume=9 |issue=4 |pages=337–43 |date=2011 |pmid=21747105 |pmc=3133581 |doi=10.1370/afm.1268 |url=}}</ref>
|-
|-
|Psychology
|Psychology
|Anxiety <ref name="pmid15995029">{{cite journal |vauthors=Ramchandani PG, Hotopf M, Sandhu B, Stein A |title=The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study |journal=Pediatrics |volume=116 |issue=1 |pages=46–50 |date=July 2005 |pmid=15995029 |doi=10.1542/peds.2004-1854 |url=}}</ref>
|[[Anxiety]] <ref name="pmid15995029">{{cite journal |vauthors=Ramchandani PG, Hotopf M, Sandhu B, Stein A |title=The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study |journal=Pediatrics |volume=116 |issue=1 |pages=46–50 |date=July 2005 |pmid=15995029 |doi=10.1542/peds.2004-1854 |url=}}</ref>
|-
|-
|Others
|Others
|Toxins (lead poising)<ref name="urlLead Poisoning in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2019/0701/p24.html#afp20190701p024-b3 |title=Lead Poisoning in Children - American Family Physician |format= |work= |accessdate=}}</ref> , Sickle cell disease.
|[[Toxins]] (lead poising)<ref name="urlLead Poisoning in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2019/0701/p24.html#afp20190701p024-b3 |title=Lead Poisoning in Children - American Family Physician |format= |work= |accessdate=}}</ref> , [[Sickle cell disease]]<ref name="urlSickle Cell Disease - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/20301551/ |title=Sickle Cell Disease - PubMed |format= |work= |accessdate=}}</ref>.
|}
|}


==Differentiating [disease name] from other Diseases==
==Differentiational Diagnosis of Abdominal Pain Children==


For further information about the differential diagnosis, click [[Disease_Name differential diagnosis|here]].
For further information about the differential diagnosis, click [[abdominal pain differential diagnosis]].


==Epidemiology and Demographics==
==Epidemiology and Demographics==


*The pooled prevalence of abdominal pain in children is approximately 13.5% per 196,472 individuals worldwide.<ref name="urlEpidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis">{{cite web |url=https://doi.org/10.1371/journal.pone.0126982 |title=Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis |format= |work= |accessdate=}}</ref>
*The pooled [[prevalence]] of abdominal pain in children is approximately 13.5% per 196,472 individuals worldwide.<ref name="urlEpidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis">{{cite web |url=https://doi.org/10.1371/journal.pone.0126982 |title=Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis |format= |work= |accessdate=}}</ref>
*In 2001,the incidence of nonspecific abdominal pain was estimated to be 25% cases per 1,000 individuals in Netherland.<ref name="urlChildhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management | Annals of Family Medicine">{{cite web |url=https://www.annfammed.org/content/9/4/337.long |title=Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management &#124; Annals of Family Medicine |format= |work= |accessdate=}}</ref>
*Abdominal pain is about 5% of presented cases in [[pediatrics]], [[surgery]] is required only in 7% of cases, and non-specific [[diagnosis]] in up to 15%<ref name="urlAbdo pain in children">{{cite web |url=https://www.slideshare.net/arjsrao/abdominal-pain-in-children-for-slideshare |title=Abdo pain in children |format= |work= |accessdate=}}</ref>.
* Incidence of appendicitis is 11/10,000 population per year<ref name="urlAbdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar">{{cite web |url=https://www.slideshare.net/HELPLibrary/abdominal-pain-in-children-by-prof-dr-sushmita-bhatnagar?qid=e09ccf6e-5a32-4f8e-bce9-8a4f11c003f3&v=&b=&from_search=5 |title=Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar |format= |work= |accessdate=}}</ref>
*In 2001,the [[Incidence (epidemiology)|incidence]] of nonspecific abdominal pain was estimated to be 25% cases per 1,000 individuals in Netherland.<ref name="urlChildhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management | Annals of Family Medicine">{{cite web |url=https://www.annfammed.org/content/9/4/337.long |title=Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management &#124; Annals of Family Medicine |format= |work= |accessdate=}}</ref>
*[[Incidence]] of [[appendicitis]] is 11/10,000 population per year<ref name="urlAbdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar">{{cite web |url=https://www.slideshare.net/HELPLibrary/abdominal-pain-in-children-by-prof-dr-sushmita-bhatnagar?qid=e09ccf6e-5a32-4f8e-bce9-8a4f11c003f3&v=&b=&from_search=5 |title=Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar |format= |work= |accessdate=}}</ref>
*At least,20% of children present with abdominal pain,5% of them need hospitalization<ref name="urlApproach to abdominal pain">{{cite web |url=https://www.slideshare.net/ZaheenZehra/approach-to-abdominal-pain-70911730 |title=Approach to abdominal pain |format= |work= |accessdate=}}</ref>.
 
===Age===
===Age===


*Age can help in differentiating causes of abdominal pain:<ref name="urlAcute Abdominal Pain in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2016/0515/p830.html |title=Acute Abdominal Pain in Children - American Family Physician |format= |work= |accessdate=}}</ref>:
*[[Age]] can help in differentiating [[causes]] of [[abdominal pain]]:<ref name="urlAcute Abdominal Pain in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2016/0515/p830.html |title=Acute Abdominal Pain in Children - American Family Physician |format= |work= |accessdate=}}</ref>:
**Neonates and infants:  
**[[Neonates]] and [[infants]]:  
***Most common presentation in this age group is due to congenital anomalies and prematurity. For example Necrotizing enterocolitis and  Meckel's diverticulum, Hirschsprung's disease, volvulus, stenosis or congenial atresia causing intestinal obstruction. Also intussusception can cause abdominal pain in this age group<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
***Most common presentation in this age group is due to [[congenital anomalies]] and prematurity. For example [[Necrotizing enterocolitis]] and  [[Meckel's diverticulum]], [[Hirschsprung's disease]], [[volvulus]], [[stenosis]] or [[congenial atresia]] causing [[intestinal obstruction]]. Also [[intussusception]] can cause [[abdominal pain]] in this age group<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
**School-age children:  
**School-age children:  
***Most common causes of abdominal pain in this age group are idiopathic constipation and infectious causes. other causes may include  Functional abdominal pain and abdominal migraine.<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>
***Most common causes of [[abdominal pain]] in this age group are idiopathic [[constipation]] and [[infectious]] causes. other causes may include  functional [[abdominal pain]] and [[abdominal migraine]].<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>
**Adolescents:  
**Adolescents:  
***In female adolescents causes related to menstruation,  ovarian torsion and pregnancy might be the underlying cause of the pain<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
***In female adolescents causes related to [[menstruation]],  [[ovarian torsion]] and [[pregnancy]] might be the underlying cause of the [[pain]]<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
***In male adolescents testicular torsion should be considered<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
***In male adolescents [[testicular torsion]] should be considered<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
***Other causes to consider in both genders that's cause abdominal pain in this age group include irritable bowel syndrome, sexually transmitted diseases and inflammatory bowel disease<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
***Other [[causes]] to consider in both genders that's cause abdominal pain in this age group include [[irritable bowel syndrome]], [[sexually transmitted diseases]] and [[inflammatory bowel disease]]<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach#referencePop39 |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.


===Gender===
===Gender===


*Females are more commonly affected with abdominal pain than males.<ref name="pmid15630915">{{cite journal| author=BEACH Program, AIHW General Practice Statistics and Classification Unit| title=Presentations of abdominal pain in Australian general practice. | journal=Aust Fam Physician | year= 2004 | volume= 33 | issue= 12 | pages= 968-9 | pmid=15630915 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15630915  }} </ref>
*Females are more commonly affected with abdominal pain than males.<ref name="pmid15630915">{{cite journal| author=BEACH Program, AIHW General Practice Statistics and Classification Unit| title=Presentations of abdominal pain in Australian general practice. | journal=Aust Fam Physician | year= 2004 | volume= 33 | issue= 12 | pages= 968-9 | pmid=15630915 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15630915  }} </ref>
*Appendicitis male to female ratio is (1.4:1) with life time risk of 8.6% in males and 6.7% in females<ref name="urlAbdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar">{{cite web |url=https://www.slideshare.net/HELPLibrary/abdominal-pain-in-children-by-prof-dr-sushmita-bhatnagar?qid=e09ccf6e-5a32-4f8e-bce9-8a4f11c003f3&v=&b=&from_search=5 |title=Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar |format= |work= |accessdate=}}</ref>
*[[Appendicitis]] male to female ratio is (1.4:1) with life time risk of 8.6% in males and 6.7% in females<ref name="urlAbdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar">{{cite web |url=https://www.slideshare.net/HELPLibrary/abdominal-pain-in-children-by-prof-dr-sushmita-bhatnagar?qid=e09ccf6e-5a32-4f8e-bce9-8a4f11c003f3&v=&b=&from_search=5 |title=Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar |format= |work= |accessdate=}}</ref>
 
===Race===
===Race===


Line 101: Line 105:


*Common risk factors in the development of abdominal pain in children:
*Common risk factors in the development of abdominal pain in children:
**Anxiety , preceding emotional or physical trauma and prior gastrointestinal infection are risk factors for functional abdominal <ref name="urlRecurrent abdominal pain in pediatrics">{{cite web |url=https://www.slideshare.net/DrAhmedAwwad/recurrent-abdominal-pain-in-pediatrics?qid=5bbc1fe7-eea2-4184-952d-672b6cde10a4&v=&b=&from_search=2 |title=Recurrent abdominal pain in pediatrics |format= |work= |accessdate=}}</ref>
**[[Anxiety]] , preceding emotional or physical trauma and prior [[gastrointestinal]] infection are [[risk factors]] for functional abdominal <ref name="urlRecurrent abdominal pain in pediatrics">{{cite web |url=https://www.slideshare.net/DrAhmedAwwad/recurrent-abdominal-pain-in-pediatrics?qid=5bbc1fe7-eea2-4184-952d-672b6cde10a4&v=&b=&from_search=2 |title=Recurrent abdominal pain in pediatrics |format= |work= |accessdate=}}</ref>
**Some environmental factors along with specific genetic predisposition are linked to crohn's disease.<ref name="pmid30485038">{{cite journal |vauthors=Veauthier B, Hornecker JR |title=Crohn's Disease: Diagnosis and Management |journal=Am Fam Physician |volume=98 |issue=11 |pages=661–669 |date=December 2018 |pmid=30485038 |doi= |url=}}</ref>
**Some [[environmental factor]]<nowiki/>s along with specific genetic predisposition are linked to [[crohn's disease]].<ref name="pmid30485038">{{cite journal |vauthors=Veauthier B, Hornecker JR |title=Crohn's Disease: Diagnosis and Management |journal=Am Fam Physician |volume=98 |issue=11 |pages=661–669 |date=December 2018 |pmid=30485038 |doi= |url=}}</ref>


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==


*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Abdominal pain is a common presenting symptom in [[pediatrics]] primary care. Most of times it's due to [[benign]] causes without risk for [[complications]], but severe abdominal pain maybe an alarming sign for abdominal pathology that requires surgical intervention<ref name="urlwww.longdom.org">{{cite web |url=https://www.longdom.org/open-access/epidemiological-aspects-of-abdominal-pain-in-children-at-the-el-rapha-polyclinic-in-libreville--gabon-2572-0775-1000126.pdf |title=www.longdom.org |format= |work= |accessdate=}}</ref>
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*Early clinical features of [[acute appendicitis]] include pain that's start in the middle of the abdomen and radiate to the right iliac fossa, followed y fever and vomiting<ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2460552/pdf/brmedj07573-0001.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>.
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Prognosis of [[infantile colic]] is generally good,One self-reporting parent questionnaire on crying patterns found that 29% of infants aged 1 to 3 months cried for more than 3 hours a day, but the estimated prevalence of the age of 4 to 6 months found to be between 7% to 11%<ref name="urlColic in infants">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907620/ |title=Colic in infants |format= |work= |accessdate=}}</ref>.
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===


*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
*The diagnosis of appendicitis is made with Pediatrics Appendicitis score<ref name="urlPediatric abdominal pain">{{cite web |url=https://www.slideshare.net/Delfinapr/pediatric-abdominal-pain-74211893?qid=2861a1bb-40f6-4c3f-88cb-1c3f9016f134&v=&b=&from_search=4 |title=Pediatric abdominal pain |format= |work= |accessdate=}}</ref> :
*
 
{| class="wikitable"
|+Pediatrics Appendicitis score
!'''Variable'''
!'''Score'''
|-
|'''Pain migrating to right lower quadrant'''
|'''1'''
|-
|'''Anorexia'''
|'''1'''
|-
|'''Nausea/vomiting'''
|'''1'''
|-
|'''Fever>38'''
|'''1'''
|-
|'''Right Iliac Fossa Pain'''
|'''2'''
|-
|'''Pain with Cough/Percussion/Hopping'''
|'''2'''
|-
|'''White Blood Cell Count>10,000 cells/ml'''
|'''1'''
|-
|'''Neutrophils count>7,500'''
|'''1'''
|-
|'''Total score'''
|'''10'''
|}
 
*If the score is 5 or less: Appendicitis is less likely or excluded, If the score is more than 5: Appendicitis is high likely to be the diagnosis<ref name="urlPediatric appendicitis score: A retrospective analysis">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788473/ |title=Pediatric appendicitis score: A retrospective analysis |format= |work= |accessdate=}}</ref>.
 
*The diagnosis of Functional abdominal pain is established by using New Rome IV Criteria<ref name="urlFunctional Disorders: Children and Adolescents - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/27144632/ |title=Functional Disorders: Children and Adolescents - PubMed |format= |work= |accessdate=}}</ref>:
**All aspects of criteria must be reached for at least two month before the diagnosis, and the criteria must be fulfilled for at least four time per month<ref name="urlFunctional Abdominal Pain In Children - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK537298/ |title=Functional Abdominal Pain In Children - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.
**New Rome IV Criteria include all of the following <ref name="urlFunctional Abdominal Pain In Children - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK537298/ |title=Functional Abdominal Pain In Children - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>:
***Abdominal pain that may occur in episodic or continuous manner, pain that not occur only during physiological events like eating<ref name="urlFunctional Abdominal Pain In Children - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK537298/ |title=Functional Abdominal Pain In Children - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.
***Not fulfill the criteria of any other functional GI disorders, like irritable bowel syndrome and abdominal migraine<ref name="urlFunctional Abdominal Pain In Children - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK537298/ |title=Functional Abdominal Pain In Children - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.
***Abdominal pain that can not fully explained after full assessment<ref name="urlFunctional Abdominal Pain In Children - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK537298/ |title=Functional Abdominal Pain In Children - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.


:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]
===Symptoms===
===Symptoms===


*[Disease name] is usually asymptomatic.
*First, Red flag symptoms must be excluded:
*Symptoms of [disease name] may include the following:
**Weight loss<ref name="urlApproach to pediatric abdominal pain">{{cite web |url=https://www.slideshare.net/mehrkamran/approach-to-pediatric-abdominal-pain |title=Approach to pediatric abdominal pain |format= |work= |accessdate=}}</ref>.
**Hemodynamic instability<ref name="urlApproach to pediatric abdominal pain">{{cite web |url=https://www.slideshare.net/mehrkamran/approach-to-pediatric-abdominal-pain |title=Approach to pediatric abdominal pain |format= |work= |accessdate=}}</ref>.
**Bilious vomiting<ref name="urlApproach to pediatric abdominal pain">{{cite web |url=https://www.slideshare.net/mehrkamran/approach-to-pediatric-abdominal-pain |title=Approach to pediatric abdominal pain |format= |work= |accessdate=}}</ref>.
**Bloody vomiting or stool<ref name="urlApproach to pediatric abdominal pain">{{cite web |url=https://www.slideshare.net/mehrkamran/approach-to-pediatric-abdominal-pain |title=Approach to pediatric abdominal pain |format= |work= |accessdate=}}</ref>.
**Abdominal pain that wake up the child at night<ref name="urlApproach to pediatric abdominal pain">{{cite web |url=https://www.slideshare.net/mehrkamran/approach-to-pediatric-abdominal-pain |title=Approach to pediatric abdominal pain |format= |work= |accessdate=}}</ref>.
*Symptoms associated with abdominal pain may vary according to the cause<ref name="urlAbdominal pain in pediatrics">{{cite web |url=https://www.slideshare.net/MaryamMajidAlEzairej/abdominal-pain-in-pediatrics-102119600 |title=Abdominal pain in pediatrics |format= |work= |accessdate=}}</ref>:
 
{| class="wikitable"
|+
!Disease
!Associated Sympyoms
|-
|Colic
|Irritability, paroxysmal crying<ref name="urlAbdominal pain in pediatrics2">{{cite web |url=https://www.slideshare.net/MaryamMajidAlEzairej/abdominal-pain-in-pediatrics-102119600 |title=Abdominal pain in pediatrics |format= |work= |accessdate=}}</ref>
|-
|Appendicitis
|Vomiting,fever, localized right lower quadrant tenderness<ref name="urlAbdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar2">{{cite web |url=https://www.slideshare.net/HELPLibrary/abdominal-pain-in-children-by-prof-dr-sushmita-bhatnagar |title=Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar |format= |work= |accessdate=}}</ref>.
|-
|Irritable bowel syndrome
|Diarrhea, Constipation<ref name="urlAbdominal pain in children2">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.
|-
|Hepatitis
|jaundice<ref name="urlAbdominal pain in pediatrics3">{{cite web |url=https://www.slideshare.net/MaryamMajidAlEzairej/abdominal-pain-in-pediatrics-102119600 |title=Abdominal pain in pediatrics |format= |work= |accessdate=}}</ref>
|-
|Henchon-schonlein purpura
|Skin Rash<ref name="urlAbdominal pain in pediatrics4">{{cite web |url=https://www.slideshare.net/MaryamMajidAlEzairej/abdominal-pain-in-pediatrics-102119600 |title=Abdominal pain in pediatrics |format= |work= |accessdate=}}</ref>
|-
|Urolithiasis
|Hematuria<ref name="urlAbdominal pain in children3">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
|-
|Pyelonephritis
|Dysuria, fever, urinary frequency, vomiting.<ref name="urlAbdominal pain in children4">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>
|}


:*[symptom 1]
:*[symptom 2]
:*[symptom 3]
:*[symptom 4]
:*[symptom 5]
:*[symptom 6]
===Physical Examination===
===Physical Examination===


*Patients with [disease name] usually appear [general appearance].
*First, check vital signs, growth parameters and if there is evidence of failure to thrive.  <ref name="urlApproach to pediatric abdominal pain">{{cite web |url=https://www.slideshare.net/mehrkamran/approach-to-pediatric-abdominal-pain |title=Approach to pediatric abdominal pain |format= |work= |accessdate=}}</ref>.
*Physical examination may be remarkable for:
*Inspect abdominal wall contour, protrusions, or skin abnormalities.<ref name="urlApproach to pediatric abdominal pain">{{cite web |url=https://www.slideshare.net/mehrkamran/approach-to-pediatric-abdominal-pain |title=Approach to pediatric abdominal pain |format= |work= |accessdate=}}</ref>
 
*Palpate superficially while looking to patient's face.<ref name="urlAbdo pain in children">{{cite web |url=https://www.slideshare.net/arjsrao/abdominal-pain-in-children-for-slideshare |title=Abdo pain in children |format= |work= |accessdate=}}</ref>
:*[finding 1]
*Deep palpation for masses, kidney, spleen and liver<ref name="urlAbdo pain in children">{{cite web |url=https://www.slideshare.net/arjsrao/abdominal-pain-in-children-for-slideshare |title=Abdo pain in children |format= |work= |accessdate=}}</ref>.
:*[finding 2]
*Percussion and auscultation<ref name="urlApproach to pediatric abdominal pain">{{cite web |url=https://www.slideshare.net/mehrkamran/approach-to-pediatric-abdominal-pain |title=Approach to pediatric abdominal pain |format= |work= |accessdate=}}</ref>.
:*[finding 3]
*Digital rectal examinations and genital examinations<ref name="urlAbdominal pain in pediatrics">{{cite web |url=https://www.slideshare.net/MaryamMajidAlEzairej/abdominal-pain-in-pediatrics-102119600 |title=Abdominal pain in pediatrics |format= |work= |accessdate=}}</ref>
:*[finding 4]
:*[finding 5]
:*[finding 6]


===Laboratory Findings===
===Laboratory Findings===


*There are no specific laboratory findings associated with [disease name].
*Initial laboratory tests according to symptoms include:
 
**Complete blood count, Urine analysis, Stool analysis.<ref name="urlRecurrent abdominal pain in children">{{cite web |url=https://www.slideshare.net/samialbdairat/recurrent-abdominal-pain-in-children-40856576?qid=e7418c0c-91f4-41d9-9462-c1cee40eb97b&v=&b=&from_search=3 |title=Recurrent abdominal pain in children |format= |work= |accessdate=}}</ref>
*A  [positive/negative] [test name] is diagnostic of [disease name].
**Liver enzyme, pancreatic enzymes if liver and pancreas diseases in suspected<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
**Electrolyte (Sodium and  serum bicarbonate levels) and creatinine, and glucose levels are useful in assessment of dehydration in patient with gastroenteritis<ref name="urlGastroenteritis in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2019/0201/p159.html |title=Gastroenteritis in Children - American Family Physician |format= |work= |accessdate=}}</ref>
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
There are no ECG findings associated with abdominal pain in children.
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].


OR
*Plain abdominal pain X-ray may show evidence of bowel obstruction, free air and kidney stone<ref name="urlAbdominal pain in children">{{cite web |url=https://www.slideshare.net/azadhaleem/abdominal-pain-in-children-55395998 |title=Abdominal pain in children |format= |work= |accessdate=}}</ref>.


An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
[[image:Perforated-necrotising-enterocolitis.jpg|300px|none|thumb|Case courtesy of Dr Jeremy Jones, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/62793">rID: 62793</a>]]
[[image:Small-bowel-obstruction-15.jpg|300px|none|thumb|Case courtesy of Dr Ian Bickle, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/34633">rID: 34633</a>]]


OR
===Ultrasound===


There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*Ultrasound  may be helpful in the diagnosis of appendicitis <ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
*Findings on an ultrasound suggestive of appendicitis include:
**aperistaltic, non-compressible, width(>6 mm outer diameter), when compressed it's appears round<ref name="urlAppendicitis | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/appendicitis-2?lang=us |title=Appendicitis &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>.


===Echocardiography or Ultrasound===
[[image:Acute-appendicitis-paediatric-5.jpg|none|thumbnail|300px|Case courtesy of Dr Alborz Jahangiri, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/48029">rID: 48029</a>]]
There are no echocardiography/ultrasound findings associated with [disease name].


OR
*Ultrasound may be useful in diagnosing  urinary tract (including kidneys) anatomical abnormalities, including nephrolithiasis and associated complications such as hydronephrosis <ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.


Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
[[image:Hydronephrosis-due-to-ureteral-stones.png|none|thumbnail|300px|Case courtesy of Dr Bruno Di Muzio, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/21885">rID: 21885</a>]] [[image:Hydronephrosis-due-to-ureteral-stones 2.png|none|thumbnail|300px|case courtesy of Dr Bruno Di Muzio, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/21885">rID: 21885</a>]]


OR
*Ultrasound is used in diagnosis of [[intussusception]] , classic finding on ultrasound<ref name="urlIntussusception | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/intussusception?lang=us |title=Intussusception &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>:
 
**[[Target sign]] [[image:Intussusception-3.jpg|none|thumbnail|300px|Case courtesy of Assoc Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/6502">rID: 6502</a]]
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
**[[Pseudokidney sign]] [[image:Intussusception-with-pseudokidney-and-target-sign-1.jpg|none|thumbnail|300px|Case courtesy of Dr Tee Yu Jin, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/70238">rID: 70238</a>]]


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].


OR
*Abdominal CT scan may be helpful in the diagnosis of acute [[appendicitis]]<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>. Findings on CT scan suggestive of acute [[appendicitis]] include:
 
**Dilation of appendix (>6 mm diameter)<ref name="urlAppendicitis | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/appendicitis-2?lang=us |title=Appendicitis &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
**Enhancement of appendiceal wall and wall thickness (>3mm diameter) <ref name="urlAppendicitis | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/appendicitis-2?lang=us |title=Appendicitis &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>
 
**Cecal apex thickness<ref name="urlAppendicitis | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/appendicitis-2?lang=us |title=Appendicitis &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>.[[image:Early-acute-appendicitis-1.jpeg|200px|thumb|none|Case courtesy of Dr Naim Qaqish, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/72705">rID: 72705</a>]]
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR


There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*Abdominal MRI may be helpful in the diagnosis of appendicitis, with sensitivity of 96% and specificity  of 96%<ref name="urlAppendicitis (summary) | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/appendicitis-summary?lang=us |title=Appendicitis (summary) &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref> .Finding on MRI has many similar findings to CT scan<ref name="urlAppendicitis (summary) | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/appendicitis-summary?lang=us |title=Appendicitis (summary) &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>.


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].


OR
*Technetium-99m pertechnetate scan may be helpful in the diagnosis of suspected [[Meckel's diverticulum]]<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>. Identification of an ectopic gastric mucosa diagnostic of [[Meckel's diverticulum]] <ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.


[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
[[image:Positive-meckels-scan-001.jpg|300px|thumb|center|]]


===Other Diagnostic Studies===
===Other Diagnostic Studies===


*[Disease name] may also be diagnosed using [diagnostic study name].
*High-grade [[vesicoureteral reflux]] or [[obstructive uropathy]] can be diagnosed using [[voiding cystourethrogram (VCUG)]]<ref name="urlAssessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice">{{cite web |url=https://bestpractice.bmj.com/topics/en-gb/787/diagnosis-approach |title=Assessment of abdominal pain in children - Diagnosis Approach &#124; BMJ Best Practice |format= |work= |accessdate=}}</ref>.
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
 
[[image:Vesicoureteric-reflux-grade-v-1.PNG|300px|thumb|none|Case courtesy of Dr Aditya Shetty, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/28005">rID: 28005</a>]]


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===


*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The mainstay of therapy for [[acute gastroenteritis]] depends on the degree of dehydration ranging from simple oral rehydration at home to hospital admission<ref name="urlAcute gastroenteritis in children">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764079/ |title=Acute gastroenteritis in children |format= |work= |accessdate=}}</ref>.
*In [[functional abdominal pain]] if bloating is predominate symptom, dietary measures may be effective for example, a low-FODMAP diet to exclude foods with certain types of carbohydrates including wheat, various fruits, lactose, fructose, and some artificial sweeteners<ref name="urlFunctional Abdominal Pain In Children - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK537298/ |title=Functional Abdominal Pain In Children - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>. If constipation is a predominate symptoms, incorporating non-stimulant laxatives such as PEG-3350 or increased fiber diets can be helpful<ref name="urlFunctional Abdominal Pain In Children - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK537298/ |title=Functional Abdominal Pain In Children - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>. Pharmacological treatment with drugs like selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) are often used to treat functional abdominal pain<ref name="urlFunctional Abdominal Pain In Children - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK537298/ |title=Functional Abdominal Pain In Children - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>.
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
 
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
===Surgery===
===Surgery===


*Surgery is the mainstay of therapy for [disease name].
*Surgery is the mainstay of therapy for appendicitis, which can be done either laparoscopically or open<ref name="urlAppendicitis | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/appendicitis-2?lang=us |title=Appendicitis &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref> .
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
 
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
===Prevention===
===Prevention===


*There are no primary preventive measures available for [disease name].
*Effective measures for the primary prevention of [[acute gastroenteritis]] include handwashing, breastfeeding, and rotavirus vaccination<ref name="urlGastroenteritis in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2019/0201/p159.html#sec-3 |title=Gastroenteritis in Children - American Family Physician |format= |work= |accessdate=}}</ref>.
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].


==References==
==References==

Latest revision as of 02:25, 8 April 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Synonyms and keywords: Abdominal pain in kids

Overview

Abdominal pain in children is a common presenting symptom in pediatrics primary care. There's multiple causes of abdominal pain that require different types of investigations and treatment options.

Historical Perspective

  • Celiac disease was first discovered by Dutch pediatricians, in late 1940s[1].
  • In late 1980s, the first classification and diagnostic criteria for functional gastrointestinal disorders was developed by a group of international experts were recruited by Professor Aldo Torsoli from Italy to develop Working Teams for the International Gastroenterology meeting in Rome 1988 to the goal was to answer difficult questions using a consensus methodology through the Delphi approach about a group of gastrointestinal disorders that had little scientific-based evidence to understand etiology pathophysiology and treatment at the time[2].
  • In May of 2016, after Rome III had been in effect for a decade, Rome IV was released[3]. It is a result of collective work by committees that included more than 100 leading functional GI experts[3].

Classification

  • Abdominal pain in children may be classified according to age into two groups:[4]
    • Abdominal pain in children below five years old.
    • Abdominal pain in children above five years old.
  • Other method for classification of abdominal pain can be according to the duration of the pain[5]:
    • Acute Abdominal pain(less than 1 week).
    • Chronic Abdominal pain(more than 1 week).

Pathophysiology

  • The pathogenesis of abdominal pain is related to either insult to intra-abdominal structures or extra-abdominal structure. Also it can be due to injury to somatic structures that's overlay the abdominal wall [6].
  • On Summary the pathophysiology of abdominal pain maybe due to :
    • Visceral Pain:
      • Result when there's a damage to nerve within the abdomen.[6]
      • Due to the fact that visceral nerve fibers that responsible for pain sensation are non-myelinated, the visceral pain is Vague, dull, poorly localized and slow on onset.[6]
      • Different types of stimuli including chemical, osmotic and even normal peristalsis can stimulate these fibers.[6]
      • Visceral pain is always sensed when the threshold of intensity or duration is reached.[6]
      • Mild stimuli may result in sensing non-painful or vaguely un-comfortable sensation, in contrast to powerful stimulation to visceral nerve fibers which causes pain.[6]
      • Example for pain caused due to over-sensation of visceral nerve fibers is functional abdominal pain.[6]
    • Somatic Pain:
    • Referred Pain:

Causes

There is a wide range of causes for pediatric abdominal pain which maybe due to a disease in variety of systems. In general, differentiating between acute and chronic pain in children is not easy, Despite it's being benign conditions in most children presenting with abdominal pain but some serious conditions may be the cause of the abdominal pain. On the table below there's some systems and related diseases that can cause abdominal pain in children:[7]

Causes of Abdominal pain In Children
System Disesease
Gastrointestinal Appendicitis[8], Gastrointestinal reflux disease[9], constipation [9],irritable bowel syndrome[10], celiac disease [11],Meckel's diverticulum[12], Intussusception[13], Volvulus[14].functional dyspepsia (FD)[15], abdominal migraine (AM)[15], functional abdominal pain (FAP) and functional abdominal pain syndrome (FAPS)[15]
Genitourinary Nephrolithiasis[16] , urinary tract infection[17].
Infections viral (mesenteric adenitis)[18], gastroenteritis[19],Multisystem Inflammatory Syndrome in Children (MIS-C) caused by covid-19[20]
Gynecologic Dysmenorrhea.[21]
Psychology Anxiety [22]
Others Toxins (lead poising)[23] , Sickle cell disease[24].

Differentiational Diagnosis of Abdominal Pain Children

For further information about the differential diagnosis, click abdominal pain differential diagnosis.

Epidemiology and Demographics

  • The pooled prevalence of abdominal pain in children is approximately 13.5% per 196,472 individuals worldwide.[15]
  • Abdominal pain is about 5% of presented cases in pediatrics, surgery is required only in 7% of cases, and non-specific diagnosis in up to 15%[25].
  • In 2001,the incidence of nonspecific abdominal pain was estimated to be 25% cases per 1,000 individuals in Netherland.[26]
  • Incidence of appendicitis is 11/10,000 population per year[27]
  • At least,20% of children present with abdominal pain,5% of them need hospitalization[28].

Age

Gender

  • Females are more commonly affected with abdominal pain than males.[31]
  • Appendicitis male to female ratio is (1.4:1) with life time risk of 8.6% in males and 6.7% in females[27]

Race

  • There is no racial predilection for abdominal pain in children

Risk Factors

Natural History, Complications and Prognosis

  • Abdominal pain is a common presenting symptom in pediatrics primary care. Most of times it's due to benign causes without risk for complications, but severe abdominal pain maybe an alarming sign for abdominal pathology that requires surgical intervention[34]
  • Early clinical features of acute appendicitis include pain that's start in the middle of the abdomen and radiate to the right iliac fossa, followed y fever and vomiting[35].
  • Prognosis of infantile colic is generally good,One self-reporting parent questionnaire on crying patterns found that 29% of infants aged 1 to 3 months cried for more than 3 hours a day, but the estimated prevalence of the age of 4 to 6 months found to be between 7% to 11%[36].

Diagnosis

Diagnostic Criteria

  • The diagnosis of appendicitis is made with Pediatrics Appendicitis score[37] :
Pediatrics Appendicitis score
Variable Score
Pain migrating to right lower quadrant 1
Anorexia 1
Nausea/vomiting 1
Fever>38 1
Right Iliac Fossa Pain 2
Pain with Cough/Percussion/Hopping 2
White Blood Cell Count>10,000 cells/ml 1
Neutrophils count>7,500 1
Total score 10
  • If the score is 5 or less: Appendicitis is less likely or excluded, If the score is more than 5: Appendicitis is high likely to be the diagnosis[38].
  • The diagnosis of Functional abdominal pain is established by using New Rome IV Criteria[39]:
    • All aspects of criteria must be reached for at least two month before the diagnosis, and the criteria must be fulfilled for at least four time per month[40].
    • New Rome IV Criteria include all of the following [40]:
      • Abdominal pain that may occur in episodic or continuous manner, pain that not occur only during physiological events like eating[40].
      • Not fulfill the criteria of any other functional GI disorders, like irritable bowel syndrome and abdominal migraine[40].
      • Abdominal pain that can not fully explained after full assessment[40].

Symptoms

  • First, Red flag symptoms must be excluded:
    • Weight loss[41].
    • Hemodynamic instability[41].
    • Bilious vomiting[41].
    • Bloody vomiting or stool[41].
    • Abdominal pain that wake up the child at night[41].
  • Symptoms associated with abdominal pain may vary according to the cause[42]:
Disease Associated Sympyoms
Colic Irritability, paroxysmal crying[43]
Appendicitis Vomiting,fever, localized right lower quadrant tenderness[44].
Irritable bowel syndrome Diarrhea, Constipation[45].
Hepatitis jaundice[46]
Henchon-schonlein purpura Skin Rash[47]
Urolithiasis Hematuria[48]
Pyelonephritis Dysuria, fever, urinary frequency, vomiting.[49]

Physical Examination

  • First, check vital signs, growth parameters and if there is evidence of failure to thrive. [41].
  • Inspect abdominal wall contour, protrusions, or skin abnormalities.[41]
  • Palpate superficially while looking to patient's face.[25]
  • Deep palpation for masses, kidney, spleen and liver[25].
  • Percussion and auscultation[41].
  • Digital rectal examinations and genital examinations[42]

Laboratory Findings

  • Initial laboratory tests according to symptoms include:
    • Complete blood count, Urine analysis, Stool analysis.[50]
    • Liver enzyme, pancreatic enzymes if liver and pancreas diseases in suspected[30].
    • Electrolyte (Sodium and serum bicarbonate levels) and creatinine, and glucose levels are useful in assessment of dehydration in patient with gastroenteritis[51]

Electrocardiogram

There are no ECG findings associated with abdominal pain in children.

X-ray

  • Plain abdominal pain X-ray may show evidence of bowel obstruction, free air and kidney stone[6].
Case courtesy of Dr Jeremy Jones, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/62793">rID: 62793</a>
Case courtesy of Dr Ian Bickle, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/34633">rID: 34633</a>

Ultrasound

  • Ultrasound may be helpful in the diagnosis of appendicitis [30].
  • Findings on an ultrasound suggestive of appendicitis include:
    • aperistaltic, non-compressible, width(>6 mm outer diameter), when compressed it's appears round[52].
Case courtesy of Dr Alborz Jahangiri, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/48029">rID: 48029</a>
  • Ultrasound may be useful in diagnosing urinary tract (including kidneys) anatomical abnormalities, including nephrolithiasis and associated complications such as hydronephrosis [30].
Case courtesy of Dr Bruno Di Muzio, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/21885">rID: 21885</a>
case courtesy of Dr Bruno Di Muzio, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/21885">rID: 21885</a>

CT scan

MRI

  • Abdominal MRI may be helpful in the diagnosis of appendicitis, with sensitivity of 96% and specificity of 96%[54] .Finding on MRI has many similar findings to CT scan[54].

Other Imaging Findings

Other Diagnostic Studies

Case courtesy of Dr Aditya Shetty, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/28005">rID: 28005</a>

Treatment

Medical Therapy

  • The mainstay of therapy for acute gastroenteritis depends on the degree of dehydration ranging from simple oral rehydration at home to hospital admission[55].
  • In functional abdominal pain if bloating is predominate symptom, dietary measures may be effective for example, a low-FODMAP diet to exclude foods with certain types of carbohydrates including wheat, various fruits, lactose, fructose, and some artificial sweeteners[40]. If constipation is a predominate symptoms, incorporating non-stimulant laxatives such as PEG-3350 or increased fiber diets can be helpful[40]. Pharmacological treatment with drugs like selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) are often used to treat functional abdominal pain[40].

Surgery

  • Surgery is the mainstay of therapy for appendicitis, which can be done either laparoscopically or open[52] .

Prevention

  • Effective measures for the primary prevention of acute gastroenteritis include handwashing, breastfeeding, and rotavirus vaccination[51].

References

  1. ↑ "CELIAC DISEASE".
  2. ↑ "What Is New in Rome IV".
  3. ↑ 3.0 3.1 "Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice - PubMed".
  4. ↑ Short AR (1935). "ABDOMINAL PAIN IN CHILDREN". Br Med J. 1 (3883): 1157–9. doi:10.1136/bmj.1.3883.1157. PMC 2460552. PMID 20779127.
  5. ↑ Eizenga W, Gieteling MJ, Berger M, Geijer RM (2013). "[Summary of the NHG guideline 'Abdominal pain in children', the 100th NHG guideline]". Ned Tijdschr Geneeskd. 157 (15): A6191. PMID 23575296.
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 "Abdominal pain in children".
  7. ↑ "Evaluation of abdominal pain in children - Etiology | BMJ Best Practice US".
  8. ↑ Marzuillo P, Germani C, Krauss BS, Barbi E (May 2015). "Appendicitis in children less than five years old: A challenge for the general practitioner". World J Clin Pediatr. 4 (2): 19–24. doi:10.5409/wjcp.v4.i2.19. PMC 4438437. PMID 26015876.
  9. ↑ 9.0 9.1 Moir CR (October 1996). "Abdominal pain in infants and children". Mayo Clin Proc. 71 (10): 984–9, quiz 989. doi:10.1016/S0025-6196(11)63773-7. PMID 8820774.
  10. ↑ Devanarayana NM, Rajindrajith S (June 2018). "Irritable bowel syndrome in children: Current knowledge, challenges and opportunities". World J Gastroenterol. 24 (21): 2211–2235. doi:10.3748/wjg.v24.i21.2211. PMC 5989237. PMID 29881232.
  11. ↑ Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean L, Mirzaa G, Amemiya A, Taylor AK, Lebwohl B, Snyder CL, Green P. PMID 20301720. Vancouver style error: initials (help); Missing or empty |title= (help)
  12. ↑ Keese D, Rolle U, Gfroerer S, Fiegel H (2019). "Symptomatic Meckel's Diverticulum in Pediatric Patients-Case Reports and Systematic Review of the Literature". Front Pediatr. 7: 267. doi:10.3389/fped.2019.00267. PMC 6606722 Check |pmc= value (help). PMID 31294008.
  13. ↑ Simon NM, Joseph J, Philip RR, Sukumaran TU, Philip R (January 2019). "Intussusception: Single Center Experience of 10 Years". Indian Pediatr. 56 (1): 29–32. PMID 30806357.
  14. ↑ Le CK, Nahirniak P, Anand S, Cooper W. PMID 28722866. Missing or empty |title= (help)
  15. ↑ 15.0 15.1 15.2 15.3 "Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis".
  16. ↑ "Nephrolithiasis - PubMed".
  17. ↑ Simões E Silva AC, Oliveira EA, Mak RH (2020). "Urinary tract infection in pediatrics: an overview". J Pediatr (Rio J). 96 Suppl 1: 65–79. doi:10.1016/j.jped.2019.10.006. PMID 31783012. Vancouver style error: missing comma (help)
  18. ↑ "Non-specific abdominal pain during school term may be due to viral infections then - PubMed".
  19. ↑ "Correction". Am Fam Physician. 99 (12): 732. June 2019. PMID 31194486.
  20. ↑ Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, Gupta A (August 2020). "Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation". Paediatr Respir Rev. doi:10.1016/j.prrv.2020.08.001. PMC 7417920 Check |pmc= value (help). PMID 32891582 Check |pmid= value (help).
  21. ↑ Gieteling MJ, Lisman-van Leeuwen Y, van der Wouden JC, Schellevis FG, Berger MY (2011). "Childhood nonspecific abdominal pain in family practice: incidence, associated factors, and management". Ann Fam Med. 9 (4): 337–43. doi:10.1370/afm.1268. PMC 3133581. PMID 21747105.
  22. ↑ Ramchandani PG, Hotopf M, Sandhu B, Stein A (July 2005). "The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study". Pediatrics. 116 (1): 46–50. doi:10.1542/peds.2004-1854. PMID 15995029.
  23. ↑ "Lead Poisoning in Children - American Family Physician".
  24. ↑ "Sickle Cell Disease - PubMed".
  25. ↑ 25.0 25.1 25.2 "Abdo pain in children".
  26. ↑ "Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management | Annals of Family Medicine".
  27. ↑ 27.0 27.1 "Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar".
  28. ↑ "Approach to abdominal pain".
  29. ↑ "Acute Abdominal Pain in Children - American Family Physician".
  30. ↑ 30.00 30.01 30.02 30.03 30.04 30.05 30.06 30.07 30.08 30.09 30.10 30.11 "Assessment of abdominal pain in children - Diagnosis Approach | BMJ Best Practice".
  31. ↑ BEACH Program, AIHW General Practice Statistics and Classification Unit (2004). "Presentations of abdominal pain in Australian general practice". Aust Fam Physician. 33 (12): 968–9. PMID 15630915.
  32. ↑ "Recurrent abdominal pain in pediatrics".
  33. ↑ Veauthier B, Hornecker JR (December 2018). "Crohn's Disease: Diagnosis and Management". Am Fam Physician. 98 (11): 661–669. PMID 30485038.
  34. ↑ "www.longdom.org" (PDF).
  35. ↑ "www.ncbi.nlm.nih.gov" (PDF).
  36. ↑ "Colic in infants".
  37. ↑ "Pediatric abdominal pain".
  38. ↑ "Pediatric appendicitis score: A retrospective analysis".
  39. ↑ "Functional Disorders: Children and Adolescents - PubMed".
  40. ↑ 40.0 40.1 40.2 40.3 40.4 40.5 40.6 40.7 "Functional Abdominal Pain In Children - StatPearls - NCBI Bookshelf".
  41. ↑ 41.0 41.1 41.2 41.3 41.4 41.5 41.6 41.7 "Approach to pediatric abdominal pain".
  42. ↑ 42.0 42.1 "Abdominal pain in pediatrics".
  43. ↑ "Abdominal pain in pediatrics".
  44. ↑ "Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar".
  45. ↑ "Abdominal pain in children".
  46. ↑ "Abdominal pain in pediatrics".
  47. ↑ "Abdominal pain in pediatrics".
  48. ↑ "Abdominal pain in children".
  49. ↑ "Abdominal pain in children".
  50. ↑ "Recurrent abdominal pain in children".
  51. ↑ 51.0 51.1 "Gastroenteritis in Children - American Family Physician".
  52. ↑ 52.0 52.1 52.2 52.3 52.4 "Appendicitis | Radiology Reference Article | Radiopaedia.org".
  53. ↑ "Intussusception | Radiology Reference Article | Radiopaedia.org".
  54. ↑ 54.0 54.1 "Appendicitis (summary) | Radiology Reference Article | Radiopaedia.org".
  55. ↑ "Acute gastroenteritis in children".
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