Pediatric emergency medicine trisk 1053 1053
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (98.94 KB, 1 trang )
right or left lower abdominal tenderness is present on physical examination to
evaluate for ovarian torsion and tubo-ovarian abscess. A pelvic examination is
required in any sexually active female with abdominal pain. Cervical discharge or
tenderness suggests the diagnosis of PID. Appropriate cultures and microscopic
examinations for sexually transmitted infections are indicated and presumptive
antimicrobial treatment should be initiated.
Other, nongynecologic etiologies of abdominal pain, including appendicitis,
must also be considered. Chronic or recurrent abdominal pain may be due to
dysmenorrhea or endometriosis. Laparoscopy may be required to confirm the
diagnosis.
SUMMARY
Abdominal pain is one of the most common complaints among children seeking
care in the ED. An algorithmic approach to the child with acute abdominal pain
should be performed, with a focus on traumatic and surgical conditions.
Generation of a differential diagnosis should take into consideration the age of the
child.
When evaluating a child with abdominal pain, the first priority should be the
stabilization of the seriously ill or injured child. The next priority is to identify the
child who requires immediate or potential surgical intervention, whether for a
traumatic injury, appendicitis, intussusception, or other congenital conditions.
Finally, a thorough examination should be conducted to determine the etiology of
abdominal pain. Laboratory evaluations and radiographic studies may be used
selectively to support or refute specific differential diagnoses generated by the
history and physical examination.
Suggested Readings and Key References
Bachur RG, Dayan PS, Bajaj L, et al. The effect of abdominal pain duration on
the accuracy of diagnostic imaging for pediatric appendicitis. Ann Emerg Med
2012;60:582–590.
Bundy DG, Byerley JS, Liles EA, et al. Does this child have appendicitis? JAMA
2007;298:438–451.
Chogle A, Mintjens S, Saps M. Pediatric IBS: an overview on pathophysiology,
diagnosis and treatment. Pediatric Ann 2014;43:e76–e82.
Fox JC, Boysen M, Gharahbaghian L, et al. Test characteristics of focused
assessment of sonography for trauma for clinically significant abdominal free
fluid in pediatric blunt abdominal trauma. Acad Emerg Med 2011;18:477–482.
