Immediate Questions

A. What are the vital signs? Because infants are diaphragmatic breathers, distention may impair respiratory function and cause tachypnea. Massive distention can compromise cardiac output, resulting in hypotension and tachycardia. Fever suggests infection, such as peritonitis or pneumonia, which can cause distention from adynamic ileus.

B. Is abdomen usually distended? Abdominal distention resulting from obesity and fecal retention occurs gradually, whereas that from intestinal obstruction is more rapid.

C. Is there associated pain or discomfort? Acute intestinal obstruction and inflammatory conditions are accompanied by pain. Distention that develops more slowly may be painless.

D. Has there been any vomiting? Vomiting, particularly bilious or feculent, is a frequent sign of intestinal obstruction.

E. When was the most recent bowel movement? What is patient's usual bowel pattern? Complete obstruction and adynamic ileus are usually associated with lack of bowel movements. Constipation is associated with infrequent or difficult passage of stool.

F. Has patient previously been well? Organomegaly, tumors, and ascites often occur in chronically ill children who have diminished activity, failure to thrive, and fever.

G. Does patient void normally? Is there any diminution in urine output? Distention may occur from hydronephrosis, obstructed bladder, polycystic kidney, or urinary ascites. Intestinal obstruction and ascites frequently produce hypovolemia.

H. If an adolescent girl, has patient had regular periods? Giant ovarian cysts and pregnancy may cause abdominal distention.

III. Differential Diagnosis. Distention may be caused by obesity, gas within or outside the GI tract, ascites, feces, a large mass, and, in adolescent females, pregnancy. As a mnemonic remember the 6 F's: Fat, Flatus, Fluid, Feces, Fearsome-sized masses, and Fetus.

A. Obesity. Strikingly increased incidence in United States; however, the abdomen in infants and children may be normally protuberant until puberty.

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