SUGGESTED READING

Cantor RM, Wittick L. Upper airway emergencies. ln: Wiebe RA,

Ahrens WR, Strange GR, Schafermeyer RW, eds. Pediatric

Emergency Medicine. 3rd ed. New York, NY: McGraw-Hill,

2009. http:/ /www.accessemergencymedicine.com/ content

.aspx?aiD=5332700. Accessed March 29, 20 12.

Rodrigo GJ, Pollack CV, Rodrigo C, Rowe BH. Heliox for nonintubated acute asthma patients. Cochrane Database of Syst Rev.

2006;( 4):CD002884.

Schibler A, Pharo TMT, Dunster KR, et al. Reduced intubation

rates for infants after introduction of high-flow nasal prong

oxygen delivery. Intens Care Med. 201 1;37:847-852.

Weiner DL. Respiratory distress. ln: Fleisher GR, Ludwig SL.

Textbook of Pediatric Emergency Medicine. 6th ed. Philadelphia,

PA: Lippincott Williams & Wilkins, 20 10, pp. 55 1-563.

Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP.

Nebulized hypertonic saline solution for acute bronchiolitis

in infants. Cochrane Database Syst Rev. 2008;(4):CD006458.

Abdominal Pain

Russ Horowitz, MD

Key Points

• Currant jelly stool is a late finding in intussusception.

• In appendicitis, young children have a very high rate of

rupture on presentation.

INTRODUCTION

Abdominal pain in children is one of the most common

complaints in pediatrics. Etiologies range from benign

conditions such as constipation to surgical emergencies

such as malrotation with volvulus. The challenge for the

clinician is to distinguish between these diseases in

preverbal children and in those with limited ability to

describe their symptoms. Some conditions such as pyloric

stenosis are unique to young children, but others, such as

appendicitis which occur in all ages, have dramatically

different presentations in the very young. Although less

common than in adults, children may still suffer from

gallstones, peptic ulcer disease, and kidney stones. Pelvic

disorders including ovarian cysts and torsion must be

considered in all girls over the age of menarche.

� Surgical Causes of Abdominal Pain

Pyloric stenosis. Usually presents in the newborn period

from 2 to 6 weeks of age. It is more common in first-born

male children (4:1) and has a familial inheritance. The

typical presentation is with postprandial projectile vomiting. After vomiting, children still appear hungry and will

readily feed. Early on they seem well, but as symptoms

progress they become dehydrated and develop the stereo ­

typical electrolyte abnormality of hypokalemic, hypochloremic metabolic alkalosis.

• If bilious vomiting is present, think malrotation with

volvu lus.