From the Guidelines
The assessment of a 14-year-old male with stomach pains in primary care should begin with a thorough history and physical examination, focusing on determining the pain characteristics, associated symptoms, and exacerbating/alleviating factors, as recommended by the American Gastroenterological Association 1. The physical exam should include vital signs, abdominal examination (tenderness, guarding, rebound), and growth parameters. Initial laboratory tests may include:
- Complete blood count
- Comprehensive metabolic panel
- Urinalysis
- Stool studies if indicated For persistent or concerning symptoms, consider:
- H. pylori testing
- Celiac screening
- Abdominal ultrasound Common causes in this age group include:
- Functional abdominal pain
- Constipation
- Gastroesophageal reflux
- Peptic ulcer disease
- Inflammatory bowel disease Treatment depends on the diagnosis but may include:
- Lifestyle modifications
- Dietary changes
- Medications like antacids (e.g., ranitidine 150mg twice daily for GERD) or antispasmodics (e.g., hyoscyamine 0.125mg as needed for functional pain) Psychological support may be beneficial as stress often contributes to abdominal pain in adolescents, as noted in the British Society of Gastroenterology guidelines on the management of irritable bowel syndrome 1. Red flags warranting urgent referral include:
- Severe pain
- Weight loss
- Nocturnal symptoms
- Family history of inflammatory bowel disease or celiac disease
- Abnormal physical findings A step-up approach for diagnosis from clinical and laboratory examination, to imaging examination should be used and tailored to the hospital's resources, as recommended by the 2017 WSES guidelines for management of intra-abdominal infections 1.
From the Research
Diagnostic Workup for Abdominal Pain in a 14-year-old Male
The diagnostic workup for a 14-year-old male presenting with abdominal pain in a primary care setting may involve a combination of history taking, physical examination, laboratory tests, and imaging studies.
- The patient's symptoms, such as the location, severity, and duration of the pain, as well as any associated symptoms like nausea, vomiting, or changes in bowel habits, should be thoroughly assessed 2.
- A physical examination, including abdominal palpation and assessment for signs of peritonitis, should be performed to help identify potential causes of the pain 2.
- Laboratory tests, such as complete blood count, electrolyte panel, and liver function tests, may be ordered to help rule out underlying conditions like infection, inflammation, or liver disease 2.
- Imaging studies, such as point-of-care ultrasound, may be used to evaluate for conditions like appendicitis or other abdominal pathologies 2.
Potential Causes of Abdominal Pain
The potential causes of abdominal pain in a 14-year-old male are diverse and may include:
- Gastroesophageal reflux disease (GERD) 3, 4, 5
- Dyspepsia 4
- Appendicitis 2
- Colorectal carcinoma, although rare in children 6
Assessment and Diagnosis
A thorough assessment and diagnosis are crucial to determine the underlying cause of the abdominal pain.
- The Pediatric Appendicitis Score (PAS) may be used to help diagnose appendicitis 2.
- Point-of-care ultrasound may be used to evaluate for appendicitis or other abdominal pathologies 2.
- Further diagnostic testing, such as computed tomography (CT) scan or magnetic resonance imaging (MRI), may be necessary to confirm the diagnosis or rule out other conditions 2.