Answer
The key to a successful outcome for an abdominal examination is the thought process of the examiner prior to starting the procedure. The abdominal examination is always a step-wise procedure, and the experienced practitioner should follow the same sequence for all patients, using age-specific modifications to achieve the desired goals. A long list of differential entities can be the cause of abdominal pain; these are well described in standard text books and recent reviews. [9, 10, 11]
Consequently, a complete history should be obtained, and a set of probable diagnostic possibilities should be entertained prior to starting the examination. One useful categorization is described in Table 1 that has been adapted by the authors from several sources. [9, 10, 11] The history should include characterization of the time frame, subjective description, severity, pattern, and location of the pain and other complaints.
Additional essential history would include presence of weight gain or loss, nausea and/or vomiting, change in bowel movements, rectal bleeding, jaundice, abdominal distension, and pruritus. Symptoms suggestive of an urgent, surgical, problem represent a different set of possibilities than those that are consistent with a chronic condition. Similarly, the patient who presents with marked morbidity should suggest different conditions from the one with subjective rather than objective complaints.
Table 1. Commonly Encountered Etiologies of Abdominal Pain in Children Arranged by Age and Characteristics (Open Table in a new window)
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Infancy (< 2 y) |
Preschool Age (2-5 y) |
School Age (>5 y) |
Adolescent |
Gastrointestinal |
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|
|
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Surgical abdominopelvic emergencies |
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|
|
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Extra-abdominal |
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|
|
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In each box the most commonly encountered etiologies are marked with an asterisk (*). All entities that have a characteristic location have these identified: E= epigastric; RU = right upper quadrant; RL = right lower quadrant; RL = right lower quadrant; LL = left lower quadrant; P = periumbilical; D = diffuse; S = subxiphoid; RLLQ = either right or left lower quadrant; RLUQ = either right or left upper quadrant; IBD = inflammatory bowel disease; IBS = Irritable bowel syndrome; UTI = urinary tract infection; AGE = acute gastroenteritis; acid peptic disease = (reflux esophagitis, gastritis, duodenitis, peptic ulcer); colonic distension (secondary to carbohydrate ie lactose, sucrose, sorbitol malabsorption)
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Abdominal palpation of a boy.
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Abdominal auscultation.
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Abdominal auscultation.
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Percussion over the liver.
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Abdominal wall findings from a handlebar injury.
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Abdominal wall findings in a passenger who was restrained with only a lap belt during a motor vehicle accident.
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Location of McBurney point illustrated on the abdomen of a male subject.
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Abdominal quadrants.
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Grey Turner sign. This 40-year-old woman complained of worsening epigastric pain of five days' duration. On examination, she had hypotension, a board-like abdomen, and extensive ecchymoses over her right loin.
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Acute pancreatitis with Cullen sign.
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A person with jaundice due to hepatic failure.
Tables
|
Infancy (< 2 y) |
Preschool Age (2-5 y) |
School Age (>5 y) |
Adolescent |
Gastrointestinal |
|
|
|
|
Surgical abdominopelvic emergencies |
|
|
|
|
Extra-abdominal |
|
|
|
|
