Tummy Ache (Pediatrics)

Today we are moving on to a completely new topic, we are going to be discussing a simple approach to pediatric GI complaints. I hope you enjoy it. The majority of this episode will be covering the life-threatening, differential diagnosis for pediatric abdominal pain. It is 12 items long, and can be thought of in regions: Upper Abdomen, Lower Abdomen, Genitourinary, and Generalized.

Also, in this episode, we will discuss how to obtain a quick pediatric GI history, the 5 most common tests that get ordered on children, and a basic GI treatment plan.

Even if your department doesn’t accept children, I still highly encourage you to listen, as this is not only a topic on your shelf, but also a huge¬†topic on Step 2.

Let me know if you have any feedback on the content, and please check out the new website emclerkship.com


  1. Hi Zach,

    I LOVE your podcast. Just wanted to quickly ask how you’d fit in Meckel’s, ulcer perforation, and bacterial peritonitis into your framework. It popped up on one of my review sources. Thanks so much for all your hard work!

    -Current MS3

    • Zack

      July 3, 2017 at 7:02 pm

      Great question. Meckels is actually very common in pediatric patients but is almost always asymptomatic. It can present as intussusception, GI bleeding, or as an appendicitis mimic. Perforations absolutely go in the differential as well but are pretty uncommon on this list. The thing to remember with those (as well as with peritonitis) is that they have peritoneal signs on abdominal exam and are pretty sick appearing. Also, with peritonitis, there typically has to be a decent amount of peritoneal fluid. Most commonly we see it in adults with cirrhosis, but it can occasionally happen in kids as well when they have CHF/nephrotic syndromes causing a bunch of peritoneal fluid that can get infected. Great job keeping your differential broad! I think the reason it’s not as high up in my framework is because I haven’t seen to many of those cases yet in my training, so my differential is skewed towards things I’ve seen and thus have read lots about!

  2. Otari Beldishevski-Shotadze

    June 2, 2019 at 11:39 pm

    Hi Zack,

    I was wondering if you could differentiate between mesenteric adenitis and appendicitis based on the clinical history/exam and testing? Thank you for your podcasts.

    • I don’t think it’s smart to try to do that. Appendicitis is too high risk of a diagnosis to miss and the symptoms overlap too much. I imagine that even if there was an objective clinical scenario where your pre-test probability for mesenteric adenitis was greater than your pretest suspicion for appendicitis, there is so much overlap of symptoms that you would still meet testing threshold for appendicitis and still require imaging which will help tell the difference.

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