Abdominal Pain

Neonate

400

Malrotation/volvulus

Rotational anomalies occur as a result of an arrest of normal rotation of the embryonic gut. Volvulus occurs when small bowel twists around the superior mesenteric artery resulting in vascular compromise to large portions of the midgut. Presentation by 1 mo (30%), by 1 yr (58%), before 5 yr (75%).

500

Necrotizing Enterocolitis

Disorder characterized by ischemic necrosis of the intestinal mucosa. One of the most common GI emergencies in newborns. Incidence of 6-7% in very low birth weight infants (< 1500 g).

2 mo - 5 yrs

100

Foreign body ingestion

80 000 cases/year in the USA. Most foreign objects reach GI tract spontaneously.. only 10-20% need endoscopic removal and < 1% surgical removal. Indications for intervention: long, sharp objects, magnets, batteries, airway or esophageal obstruction, sx of inflammation and if object still in esophagus > 24h post-ingestion.

200

Appendicitis

Rare in neonates; uncommon in infants and pre-school children; more frequent between 5-12 years and adolescents.

300

Intussusception

Invagination (telescoping) of a part of the intestine into itself. 60% < 1 yr and 80-90% are younger than 2 yrs.

400

Hirschsprung disease (also called Congenital aganglionic megacolon)

Motor disorder of the gut, which is caused by the failure of neural crest cells (precursors of enteric ganglion cells) to migrate completely during intestinal development. 1 in 5000 live births. 50-90% will fail to pass meconium within the first 48 hours of life.

500

Hemolytic uremic syndrome (HUS)

Simultaneous triade of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Causes: Shiga-toxin-producing E. coli, Strept. pneumoniae, HIV, complement gene mutations..

> 5 yrs

200

Intraabdominal abscess

Index of suspicion for an abscess should increase if the patient has a history fever, intraabdominal disease, abdominal surgery, or vague abdominal pain.

300

Perforated ulcer/Peptic ulcer disease (PUD)

Less common than in adults. Vomiting, hemorrhage, and perforation are more commonly seen in young children, while older children and teens have a presentation similar to adults consisting of epigastric pain, often occurring several hours after eating. Often due to corticosteroids or NSAIDs or idiopathic.

400

Diabetic ketoacidosis

Some patients present with anorexia, nausea, vomiting, and abdominal pain, which at times can mimic appendicitis or gastroenteritis.

500

Myocarditis and Pericarditis

Severe abdominal pain, often accompanied by gastrointestinal symptoms and fever, may be the first and most prominent symptom of myocardial or pericardial disease.

Common

400

Gastroenteritis

Diarrhea is caused by intestinal infection and destruction of enterocytes, which results in transudation of fluid into the intestinal lumen and net loss of fluid and salt in the stool. Usually lasts < 7 days, up to 2 weeks. In the absence of diarrhea, the diagnosis of gastroenteritis should be considered a diagnosis of exclusion.

500

Constipation

Functional constipation accounts for > 95% of cases of constipation in healthy children one year and older. Constipation is likely in children with at least two of the following characteristics: fewer than three stools weekly, fecal incontinence (usually related to encopresis), large stools palpable in the rectum or on abdominal examination, retentive posturing, or painful defecation

Functional

100

Functional Recurrent Abdominal Pain

Nearly continuous pain that has no characteristics of other functional GI disorders and no relations to bowel movements.

200

Colic

Crying for no apparent reason that lasts for ≥3 hours per day and occurs on ≥3 days per week in an otherwise healthy infant.

300

Irritable Bowel Syndrome (IBS)

Abdominal discomfort or pain associated with two or more of the following at least 25% of the time: 1. Improvement with defecation, 2. Onset associated with a change in frequency of stool, and 3. Onset associated with a change in form (appearance) of stool.

400

Functional Dyspepsia

Episodes of functional dyspepsia are usually in the upper abdomen (above the umbilicus). Symptoms can include heartburn, early satiety and bloating. NOT relieved by defecation or associated with the onset of a change in stool frequency or stool form (ie, not irritable bowel syndrome). Diagnostic criteria must include ALL of the following: • Persistent or recurrent pain or discomfort centered in the upper abdomen (above the umbilicus) • Not relieved by defecation or associated with the onset of a change in stool frequency or stool form (ie, not irritable bowel syndrome) • No evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the patient’s symptoms

500

Abdominal Migraine

In abdominal migraine, episodes tend to intense, of sudden onset and resolution and associated with signs of pallor, lethargy, nausea, vomiting, headache and/or photophobia.