It could be ureteral colic but this is uncommon in children and there is no blood in the urine indicating that a ureteral stone is unlikely. If it is intestinal obstruction, an abdominal series should show an obstructive pattern (deduction). In evaluating the case above using inductive reasoning, the symptoms of crampy mid-abdominal pain, bilious vomiting, and history of prior abdominal surgery, suggest a hypotheses of bowel obstruction. In gathering data, a complete history and physical examination should suggest a disease process, a hypothesis or diagnosis (induction) which in turn should suggest a search for confirmative or corroborative data to strengthen or disprove the diagnostic hypothesis (deduction). The search for the cause of abdominal pain is a good example of both inductive and deductive reasoning. On the other hand peritoneal and solid organ pain such as caused by infection or trauma is aggravated by motion caused by coughing, abdominal compression, and walking. These waves or cramps are exactly what we experience with early acute appendicitis and gastroenteritis and are somewhat ameliorated by writhing and massage. It coincides with the peristaltic waves of the organ as it attempts to overcome the distal obstruction such as ureteral or cystic duct stone or a fecal bolus in constipation. Hollow viscus pain such as that of an the obstructed ureter, intestine, and gallbladder is colicky or spasmodic in nature. In general, it is helpful to classify abdominal pain into two large categories: 1) pain originating in a hollow viscus, and 2) pain originating in a solid organ or the peritoneum. Further complicating the diagnosis is the young child's relative inability to communicate and his/her inability to evaluate the abstract concept of pain. Examples of these in children are most commonly acute appendicitis followed by incarcerated inguinal hernias, bowel obstruction, traumatic injury, ovarian torsion, pancreatitis, and biliary disease. In the latter category are those conditions that lead to a diagnosis of an "acute abdomen," usually leading to surgical intervention. Its importance lies in differentiating the vast majority self-limited causes of pain from those few conditions that may be life threatening. Impression: Small bowel obstruction secondary to adhesions dehydration, metabolic alkalosis and hypovolemia.Ībdominal pain is a common symptom of childhood. Abdominal series radiographs show distended ladderlike small bowel with large air/fluid levels and no large bowel gas. Urinalysis: SG 1.030, no pyuria or hematuria. Her skin turgor is decreased, but her overall color and perfusion are good.ĬBC: WBC 14.0, Hgb 16, Hct 48, Na 132, K 3.0, Cl 90, bicarb 30. She has no inguinal hernias and her external genitalia are normal. She has moderate abdominal distention with hyperactive bowel sounds, peristaltic rushes and borborygmi with generalized mild tenderness. She moves without difficulty but cries episodically because of crampy pain. Her family history is negative for other family members with similar problems.Įxam: VS T 37.0, P110, R 12, BP 100/60. ![]() Her past history is significant for an appendectomy one year ago. She has not passed any stools for the two days that she has been ill. There is no history of diarrhea, trauma, fever or coughing. ![]() She appears to be weak and her parents noticed a decrease in urination. The pain is located in the upper mid-abdomen and is associated with anorexia, nausea and four episodes of green vomitus. This is a 6 year old female presenting with a 2 day history of crampy abdominal pain. Case Based Pediatrics Chapter Case Based Pediatrics For Medical Students and Residentsĭepartment of Pediatrics, University of Hawaii John A.
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