From the Guidelines
Abdominal pain causes vary significantly across age groups due to developmental and physiological differences, with the most common causes including colic, gastroenteritis, and constipation in infants, functional abdominal pain and appendicitis in school-aged children, and diverticulitis, irritable bowel syndrome, and hernias in middle-aged adults 1.
Age Group Variations
The causes of abdominal pain differ across various age groups, including:
- Infants and toddlers (0-3 years): colic, gastroenteritis, constipation, and intussusception, with colic typically resolving by 3-4 months and manageable with gentle rocking and white noise 1.
- School-aged children (4-12 years): functional abdominal pain, appendicitis, constipation, and urinary tract infections, with prompt medical evaluation essential for appendicitis when pain localizes to the right lower quadrant with fever and vomiting 1.
- Adolescents (13-18 years): menstrual pain, inflammatory bowel disease, ovarian cysts, and testicular torsion, with ibuprofen 400mg every 6-8 hours helping to manage menstrual cramps 1.
- Young adults (19-40 years): gastritis, peptic ulcer disease, gallstones, and pancreatitis, frequently related to lifestyle factors like alcohol consumption and diet 1.
- Middle-aged adults (41-65 years): diverticulitis, irritable bowel syndrome, and hernias, with treatment for diverticulitis typically including antibiotics like ciprofloxacin 500mg twice daily plus metronidazole 500mg three times daily for 7-10 days 1.
- Elderly individuals (over 65): mesenteric ischemia, malignancies, and medication side effects, with the aging digestive system becoming more vulnerable to vascular problems and medication interactions, requiring careful evaluation of all abdominal complaints in this population 1.
Key Considerations
When evaluating abdominal pain, it is essential to consider the patient's age, medical history, and physical examination findings to determine the underlying cause and develop an effective treatment plan, with imaging playing a crucial role in narrowing the differential diagnosis and directing management 1.
From the Research
Common Causes of Abdominal Pain by Age Group
- In adults, the most common causes of acute abdominal pain are gastroenteritis and nonspecific abdominal pain, followed by cholelithiasis, urolithiasis, diverticulitis, and appendicitis 2
- In older adults (≥65 years), abdominal pain is a serious condition that can be caused by various factors, including acute cholecystitis, pancreatitis, appendicitis, diverticulitis, and small and large bowel obstructions 3, 4
- The presentation of abdominal pain in older adults may differ from that of younger patients, and is often complicated by coexistent disease, delays in presentation, and physical and social barriers 4
- In patients who have female reproductive organs, diagnoses such as ectopic pregnancy, pelvic inflammatory disease, and adnexal torsion should be considered 2
Diagnostic Approach
- The diagnostic approach to abdominal pain involves a combination of clinical evaluation, laboratory tests, and imaging studies 2, 5
- Clinical evaluation is advised to differentiate between urgent and nonurgent causes, and to guide the workup after ensuring hemodynamic stability 5
- Imaging studies, such as computed tomography and ultrasonography, are chosen based on the location of pain and index of suspicion for specific etiologies 2, 5
- Point-of-care ultrasonography can aid in the prompt diagnosis of several etiologies of acute abdominal pain, including cholelithiasis, urolithiasis, and appendicitis 2
Age-Specific Considerations
- Older adults with abdominal pain are at high risk of mortality or incident disability after the ED encounter, and require prompt evaluation and management 3
- The physical examination can be misleadingly benign in older adults, even with catastrophic conditions such as abdominal aortic aneurysm rupture and mesenteric ischemia 4
- Medication use, gallstones, and alcohol use increase the risk of pancreatitis in older adults, and advanced age is an indicator of poor prognosis for this disease 4