Abdominal Pain Care Pathway - Overview

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Assessment - Traffic Light Features

                  

Diagnosis

Common causes of abdominal pain by age

<2 Years 2 – 12 Years 12 – 16 Years
  • Gastroenteritis
  • Constipation
  • Intussusception
  • Infantile colic
  • UTI
  • Incarcerated inguinal hernia
  • Trauma
  • Pneumonia
  • Diabetes
  • Gastroenteritis
  • Mesenteric adenitis
  • Constipation
  • UTI
  • Onset of menstruation
  • Psychogenic trauma
  • Pneumonia
  • Diabetes
  • Mesenteric adenitis
  • Acute appendicitis
  • Menstruation
  • Mittelschmerz
  • Ovarian cyst torsion
  • UTI
  • Pregnancy
  • Ectopic pregnancy
  • Testicular torsion
  • Psychogenic trauma
  • Pneumonia
  • Diabetes

Diagnosis to be considered in conjunction with abdominal pain:

Symptoms and signs:
  • Vomiting
  • Diarrhoea

(do not exclude other conditions e.g. intussusception, pelvic appendicitis, pelvic abscess and inflammatory bowel disease.

Symptoms and signs:

  • Bile stained vomit
  • Colicky abdominal pain
  • Absence of normal stolling/flatus
  • Abdominal distension
  • Increased bowel sounds
  • Visible distended loops of bowel
  • Visible peristalsis
  • Scars
  • Swelling at the site of hernial orifices and of the external genitalia
  • Stool containing blood mixed with mucus

Symptoms and signs:

  • Blood mixed with stools – ask about travel history and recent anti-biotic therapy.

Symptoms and signs:

  • Blood in stools.

Symptoms and signs:

  • Blood in stools.

Symptoms and signs: 

  • Blood in stools.

Symptoms and signs: 

  • Blood in stools.

Symptoms and signs:

  • Loss of appetite.

Symptoms and signs:

  • Fever
  • Cough
  • Tachypnoea
  • Desaturation.

Symptoms and signs:

Ask about history of possible ingestions and what drugs and other toxic agents are available at home.

Symptoms and signs:

  • Examine inguinoscrotal region.

Symptoms and signs:

  • This is a surgical emergency and if suspected the appropriate surgeon should be consulted immediately.

Symptoms and signs:

  • Hepatitis may present with pain due to liver swelling.

Symptoms and signs:

  • Routine urine analysis for children presenting with abdominal pain.

Symptoms and signs:

  • Ask about possible bites and stings, adder envenomation can result in abdominal pain and vomiting.

Symptoms and signs:

  • Refusal/inability to walk
  • Slow walk/stooped forward
  • Pain on coughing or jolting
  • Lying motionless
  • Decreased/absent abdominal wall movements with respiration
  • Abdominal distension
  • Abdominal tenderness – localised/generalised
  • Abdominal guarding/rigidity
  • Percussion tenderness
  • Palpable abdominal mass (see question below)
  • Bowel sounds – absent/decreased
  • Associated non-specific signs – tachycardia, fever.

Symptoms and signs:

  • Infrequent bowel activity
  • Foul smelling wind and stools
  • Excessive flatulence
  • Irregular stool texture
  • Passing occasional enormous stools or frequent small pellets
  • Withholding or straining to stop passage of stools
  • Soiling or overflow
  • Abdominal distension
  • Poor appetite
  • Lack of energy
  • Unhappy/angry or irritable mood and general malaise.

Prescribe Movicol and refer to the Health Visitor if pre-school age or School Nurse if School Age.

Symptoms and signs:

  • Suggest pregnancy test
  • Consider ectopic pregnancy/pelvic inflammatory disease or other STD
  • Other gynaecological problems;
    • mittelschmerz
    • torsion of the ovary
    • pelvic inflammatory disease
    • imperforate hymen with hydrometrocolpos.

  • Previous abdominal surgery (adhesions)
  • Nephrotic syndrome (primary peritonitis)
  • Mediterranean background (familial Mediterranean fever)
  • Hereditary spherocytosis (cholethiasis)
  • Cystic fibrosis (meconium ileus equivalent)
  • Cystinuria
  • Porphyria.
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