Rationale

Abdominal pain is a common presentation in children. While the symptoms may result from serious abdominal pathology, in a large proportion of cases, an identifiable organic cause is not found. When a cause is identified, the cause is often age dependent.

Causal Conditions

(list not exhaustive)

1. Lower abdominal pain (e.g., appendicitis, constipation, gynecologic issues)

2. Flank pain (e.g., pyelonephritis, kidney stones)

3. Epigastric pain (e.g., gastroesophageal reflux)

4. Generalized/diffuse pain (e.g., functional, infantile colic, malabsorption)

Key Objectives

Given a pediatric patient with abdominal pain, the candidate will diagnose the cause, severity, and complications and initiate an appropriate management plan.

Enabling Objectives

Given a pediatric patient with abdominal pain, the candidate will

1. list and interpret critical findings, including those derived from

   1. a detailed history, including characteristics of the pain;

   2. an appropriate physical examination, including

      • general abdominal examination

      • special manoeuvres if relevant (e.g., rebound tenderness, shifting dullness)

      • rectal, genitourinary, and/or other system examinations if relevant

   3. the identification of causes of abdominal pain requiring a surgical procedure;

   4. the differentiation of possible psychological causes or psychosocial circumstances in case of chronic abdominal pain;

2. list and interpret critical investigations, including

   1. laboratory investigations;

   2. diagnostic imaging;

3. construct an effective initial management plan, including

   1. determining whether emergency intervention is required;

   2. determining appropriate medical, surgical, and nonpharmacologic management for common causes of abdominal pain based on age;

   3. determining whether specialized care and/or further investigations are required (e.g., endoscopy);

   4. recognizing possible underlying psychosocial issues leading to abdominal pain.