Definition of the Complaint
Abdominal pain is a common complaint in pediatrics and has an extensive list of possible causes, not all gastrointestinal in etiology. Additionally, the etiology may be acute and life-threatening or more chronic in nature. The patient’s clinical presentation, history, and physical examination along with directed testing usually elucidate the etiology and help clarify the treatment course.
Abdominal pain is usually stimulated by one of three pathways: visceral, somatic, or referred. Visceral pain is caused by a distended viscus (i.e., one of the organs of the body) that activates a local nerve and sends an impulse that travels through autonomic afferent fibers to the spinal tract and central nervous system. Precise localization of visceral pain is often difficult and frustrating because there are very few afferent nerves that travel from the viscera and the nerve fibers frequently overlap. Visceral pain is generally felt in the epigastric region, the periumbilical region, or the suprapubic area. Somatic pain, because it is carried by somatic nerves in the parietal peritoneum, muscle, or skin, is usually well localized and sharp. Referred pain, defined as abdominal pain perceived at a site remote from the actual affected viscera, can either be sharp and localized or diffuse. There is a great deal of individual variability in the experience of pain so that neuroanatomic, neurophysiologic, pathophysiologic, environmental, and psychosocial factors all play a part in the expression of pain. The frequency of the chief complaint of abdominal pain necessitates categorizing the presentation of abdominal pain into the following: acute abdominal pain and chronic abdominal pain.
In the case of acute abdominal pain, a patient or parent is usually able to pinpoint the onset of the pain to an event or time of day. If the pain is mild initially, it often becomes progressively worse and eventually interferes with sleep and normal activities. Other than intussusception (when one part of the intestine slips into itself), acute abdominal pain that requires surgical intervention does not recur and is not relieved without some intervention. Nausea, vomiting, diarrhea, fever, and anorexia often accompany acute abdominal pain. Patients most often appear acutely ill and position themselves to protect the abdomen from further examination. Chronic abdominal pain is defined as pain that lasts 2 or more weeks. Chronic abdominal pain does not usually require surgical intervention. Although formal definitions and guidelines exist, the definition basically includes any child who has abdominal pain with multiple episodes (minimum of three) over a long period (at least 3 months) without a known cause, for which the family seeks medical attention, and which interferes with the child’s ability to function. In the past, the term recurrent abdominal pain was used as well, but in 2005 the American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain suggested that the term be replaced with functional abdominal pain as it is thought to be the most common cause of chronic abdominal pain. Functional abdominal pain ...