Pediatric Abdominal Pain & Vomiting

Objectives

Upon finishing this module, the student will be able to:

  • List the differential diagnosis of abdominal pain and emesis
  • Identify the different etiologies and pathophysiology for abdominal pain
  • Discuss the initial workup for key causes of abdominal pain and emesis
  • Explain the mechanism behind vomiting and the difference between vomiting and infant spit ups.
  • Identify the main imaging modalities useful in the workup of abdominal pain and vomiting.

Initial Actions and Primary Survey

As with any patient who presents to the emergency department, the first priority is Airway, Breathing, Circulation, and initial stabilization as needed.  A focused approach focusing on the ABC’s in a child with abdominal pain and vomiting is necessary to rule out an acute cardiorespiratory process.  Abdominal pain and vomiting can be the presenting symptoms of significant cardiorespiratory disease and many etiologies of abdominal pain can cause clinical deterioration and sepsis if not addressed promptly. Initially, perform a targeted history and physical followed by a detailed directed history and physical.  Many patients with complaints of abdominal pain and vomiting will have self-limited conditions and will be stable on presentation. However, some require rapid diagnosis and stabilization / resuscitation.  Key points to identify are:

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