Principles of diagnosis

A child with acute abdominal pain can be a disconcerting experience for most doctors, and there is often little in the way of aids or investigations that can be used to arrive at a correct diagnosis. Certainly there are common conditions that cause problems in most age groups (such as appendicitis) and others that are usually confined to a specific age group (such as intussusception).

Abdominal pain is common, with most children never seeing a doctor, and, of those that do, most being seen and treated at home by a general practitioner. Of those that are taken to hospital, some recover without obvious sequelae despite the lack of a specific diagnosis. The label non-specific abdominal pain has been used for these cases, and this, in truth, will be the commonest “cause” of most acute abdominal pain that most clinicians will see.

Clinical approach

An accurate history is vital, although in younger children it is usually hearsay. Important points are the length of the current illness; previous similar episodes; periodicity if it is a colicky pain; whether it is constant, worsening, or getting better; and any related or aggravating factors. Gastrointestinal upset (such as vomiting) is common and can be a non-specific feature. The presence of bile in vomit is an important discriminant suggesting intestinal obstruction. Alternatively, substantial diarrhoea can accompany surgical pathology and should not be accepted simply as enteritis. Urinary symptoms such as dysuria and frequency can be difficult to establish in young children and again can also be entirely erroneous—both are common in a child with a pelvic appendicitis.

Examination

The examiner needs to have a patient, gentle technique, not only with the child, but …