Abdominal Pain

The evaluation of abdominal pain is problematic because the pain is often difficult to localize, and the history in children is often nonspecific. In children the differential diagnosis of abdominal pain is extensive.

Localization of Abdominal Pain

Generalized pain in the epigastrium usually comes from the stomach, duodenum, or the pancreas.
Pain in the midgut (small bowel and colon or spleen) usually localizes to the periumbilical region.
Inflammation (parietal pain) is usually well localized.
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Referred abdominal pain occurs when poorly localized visceral pain is felt at a distant location.

Pancreatitis, cholecystitis, liver abscess, or a bleeding spleen cause diaphragmatic irritation, which is referred to the ipsilateral neck and shoulders.
Intraabdominal fluid may produce shoulder pain on reclining.
Gallbladder pain may be felt in the lower back or infrascapular area.
Pancreatic pain often is referred to the posterior flank.
A migrating ureteral stone often is felt as pain radiating toward the ipsilateral groin.
Rectal or gynecological pain often is perceived as sacral pain.
Right lower lobe pneumonia may be perceived as right upper quadrant abdominal pain.

One Response to Abdominal Pain

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