Male1: A very common question, usually it is for pediatrician who is in an office, my kid has belly pain. How would you know asking questions the difference between belly pain that maybe is benign that could possibly and always be an emergency, maybe surgery. What advice would you give to someone and say this is not something benign it could be surgery.
Male2: So many kids get belly aches and they usually get better and the mom has to go the bathroom and give them a little prune juice and the great fear is that it is something serious like appendicitis and the mom sends him to the bathroom and they take a little prune juice and two or three days pass and then the appendix is perforated that everybody is regretful and it takes a long course of antibiotics and then we can add more serious consequences, so we have got a very good question here. When should the mother and the pediatrician be alerted that this is more serious and needs surgeon.
Abdominal pain associated with fever—that is the first one. Now, if there is a lot of vomiting, a lot of diarrhea, a lot of cramping, if there is no particular localization of the pain, that does sound like one of these flu bugs that get better. You call it gastroenteritis.
Male1: What about vomiting by itself and no diarrhea?
Male2: If it is just vomiting without pain-
Male1: With pain?
Male2: Now vomiting with pain would worry me and if the pain came first and it would particularly worry me and if the pain localizes to a specific area in the abdomen, it would really worry me and if the pain was in the right lower part of the belly, it sounds like appendicitis, so if you had a mid abdominal pain and the mother notices it has now moved down here to the right lower side, and there is a little fever and there is a little vomiting, that sounds like appendicitis. So unexplained fever--
Male1: What if the belly is extended. That is always an emergency?
Male2: I think abdominal distention should snap somebody to attention yes. Some kids have a full belly chronically and it would worth bringing to your pediatrician’s office. If it happens acutely, with pain, I would be very concerned.
Male1: So in other words, if you are not sure that the kid is in discomfort, you should not sit on it anyway. That is worth evaluating. The worse thing people can do is sit in an emergency room, the doctor sees the kid and gives you—do not worry too much. We always want to be careful with little kids, is that true?
Male2: Yes sir.
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