Abdominal pain in children

Abdominal pain is one of the most common reasons pediatric patients seek emergency care. The emergency physician must be able to distinguish diagnoses requiring immediate attention from self-limiting processes. Pediatric patients can be challenging, particularly those who are preverbal, and therefore, the clinician must rely on a detailed history from a parent or caregiver as well as a careful physical examination in order to narrow the differential diagnosis. This article highlights several pediatric diagnoses presenting as abdominal pain, including surgical emergencies, nonsurgical diagnoses, and extraabdominal processes, and reviews the clinical presentation, diagnostic evaluation, and management of each.     

Approach to acute abdominal pain

Evaluation of the emergency department patient with acute abdominal pain may be challenging. Many factors can obscure the clinical findings leading to incorrect diagnosis and subsequent adverse outcomes. Clinicians must consider multiple diagnoses with limited time and information, giving priority to life-threatening conditions that require expeditious management to avoid morbidity and mortality. This article seeks to provide the clinician with the clinical tools to achieve these goals by reviewing the anatomic and physiological basis of abdominal pain and key components of the history and the physical examination. In addition, this article discusses the approach to unstable patients with abdominal pain.     

Abdominal pain in special populations

Evaluation and management of acute abdominal pain in special populations can be challenging for the emergency physician. This article focuses on two specific populations: patients with altered immunologic function and postprocedural patients. Recognition of life-threatening abdominal diseases may be delayed in immunosuppressed patients because of the atypical presentations of these conditions. In postprocedural patients, evaluation of acute abdominal symptoms requires an understanding of the complications of procedures often performed by others. The unique characteristics of abdominal pain in these two populations and, more specifically, which diseases to consider and how to use appropriate testing to detect life-threatening conditions, are discussed.     

Imaging features of splenic epidermoid cyst with pathologic correlation

The spleen can be involved in a variety of cystic lesions ranging from cystic neoplasms and parasitic cysts to true and false cysts. Epidermoid splenic cyst is a rare true cyst that is developmental in origin. We present two young patients with such a cyst and illustrate their features on ultrasound, CT, and MRI with pathologic correlation.     

Ultrasound Imaging Transducer Motion during Clinical Maneuvers: Respiration,Active Straight Leg Raise Test and Abdominal Drawing In

Clinical use of ultrasound imaging by physiotherapists is increasing; however, the clinical setting may be problematic due to variability inherent in the environment. As transducer motion interferes with accurate measurement, this study aimed to measure handheld transducer motion, relative to the pelvis, during a clinical simulation involving typical maneuvers employed in a physiotherapy assessment of the lumbopelvic region. Transducer motion about three axes and through one plane was measured (Vicon, Oxford, UK) on 12 participants during three clinical maneuvers at four abdominal imaging sites. Data were grouped and means used to determine discrepancies in transducer and pelvic motion for each imaging site/maneuver combination. None of the conditions produced large transducer motions relative to the pelvis and all findings were within previously established guidelines for acceptable amounts of transducer motion. These findings suggest that an ultrasound transducer can be held relatively stationary in a clinical setting, for the maneuvers tested. (E-mail: j.l.whittaker@soton.ac.uk)     

Abdominal migraine: A childhood syndrome defined

It has long been recognized that some cases of recurrent abdominal pain in children are related to migraine, but the diagnostic criteria for abdominal migraine have not been defined. We have identified a group of children with recurrent abdominal pain who had a family history of migraine--in over half the cases in a first-degree relative--and who obtained marked relief from their symptoms from specific anti-migraine therapy. These children had a well-defined syndrome comprising episodes of midline abdominal pain of sufficient severity to interfere with normal activities and lasting for prolonged periods, frequently accompanied by pallor, headache, anorexia, nausea, and vomiting. It is proposed that these children have "abdominal migraine".     

CT平扫对腹部闭合性损伤的诊断价值

目的:探讨CT平扫对腹部闭合性损伤的诊断价值。方法:回顾分析48例急诊腹部闭合性损伤患者的CT平扫资料,评价其诊断价值。结果:48例腹部闭合性损伤患者共发现腹腔内实质性脏器损伤57处,其中9例(18.8%)患者为合并多发脏器损伤。脏器外伤的部位为肝脏14例、脾脏19例、肾脏21例、肾上腺2例及胰腺1例。腹水、下部肋骨及腰椎骨折在CT平扫,均清楚显示。结论:CT平扫能清楚显示腹水、下部肋骨及腰椎骨折,对腹腔内闭合性实质性脏器损伤的诊断有重要价值。     

Art in Imaging

This article will describe the use of medical imaging to create art. Examples of X-rays, computed tomography, and ultrasound are shown as tools for creating beauty rather than their conventional role as methods for exposing disease and injury.     

脑白质疏松症的影像诊断

目的：探讨脑白质疏松的CT、MRI影像学特点,以提高对脑白质疏松的影像学诊断认识。材料与方法：本组130例,男性83例,女性47例,年龄50岁-95岁,平均76岁。临床症状均有头晕、恶心及偏瘫、肢麻、失语、认识障碍或痴呆等神经症状,结合CT、MRI特点对照分析。结果：本病好发于50岁以上,并与年龄成正比,临床上常伴高血压、冠心病、动脉硬化、糖尿病等危险因素;渐进性痴呆和治理减退是常见表现;多伴发急性或亚急性卒中,出现感觉、语言及运动障碍。CT、MRI特征表现为双侧脑室周围脑白质大致对称性低密度及低信号灶,或并发脑梗塞、脑出血及脑萎缩。结论：熟悉本病的临床和CT、MRI特点,对提高本病的CT、MRI诊断正确率有重要价值。     

一种腹部脏器体积较精确的超声测量方法

本文提出了一种较精确的主要用于腹部脏器容积的测量和计算方法。它在计算机帮助下使用普通超声诊断仪实现其功能。通过两次手动操作游标钩画二维图像的解剖轮廓，即可迅速得到体积测值。     

正常兔腹主动脉、肾动脉声学造影的实验研究

目的 探讨动脉声学造影的价值和可行性。为声学造影剂在大、中血管中的临床应用提供理论依据。方法 正常大白兔5只，耳缘静脉注射自制脂膜氟烷超声造影剂“脂氟显”观测腹主动脉、肾动脉二维形态及彩色多普勒血流显像，对照分析造影前、后检查结果。结果 “脂氟显”造影剂在腹主动脉、肾动脉中平均显影时间为60min；造影前腹主动脉内膜显示不清，造影后回声增强，内膜线明亮清晰；造影后肾动脉彩色血流信号明显增多，多普勒视频密度与造影前相比有显著差异。结论 造影剂可显著改善大、中动脉二维、彩色血流显像，动脉声学造影切实可行。     

Recurrent Abdominal Pain in Children: Forerunner to Adult Irritable Bowel Syndrome?

ISSUES AND PURPOSE Review the etiology and pathophysiology of recurrent abdominal pain (RAP) and its potential role as a precursor to irritable bowel syndrome (IBS) in adults. CONCLUSIONS Physiological mechanisms not easily identifiable as an organic cause may underlie symptoms in RAP patients. They may be triggered by psychosocial factors that result in greater functional disability, more clinic visits, and lower academic and social competence. Of these children, 25% will experience similar symptoms as adults; many will be diagnosed with IBS. PRACTICE IMPLICATIONS Nurses can provide early and efficient management of these children's care if they view the issues of abdominal pain/discomfort from a broader focus that includes the context of the child's experiences.