When students experience abdominal pain at school, the discomfort can not only affect their ability to concentrate on their studies and fully engage in school activities, but it may also be a sign of a serious underlying medical condition. For school nurses, evaluation can prove difficult due to the often vague and nonspecific clinical findings and the wide variety of causes, ranging from minor to life-threatening. Safe and practical assessments in busy school health offices are essential to appropriately differentiating between abdominal emergencies and less serious causes of abdominal pain. In part one of this blog series, The Business of Bellyaches, we outlined the most common, non-emergent causes of abdominal pain in children and reviewed critical components of the school nurse evaluation, including obtaining a detailed history and performing a focused assessment. Below, in part two, we will discuss how to identify and manage acute abdominal pain emergencies in the school setting. 

Possible Causes of Acute Abdominal Emergencies

Most abdominal pain visits to the school nurse are due to benign, self-limiting causes. But, in the rare cases that the pain is a life-threatening condition caused by infection, injury, obstruction, or inflammation of abdominal organs, quick identification and urgent care is required.

• Appendicitis - Acute appendicitis is the most surgical cause of abdominal pain in children and happens most often between the ages of 10 and 19. Appendicitis occurs when the appendix is inflamed or blocked by hard mucus or stool. If left untreated, the swelling and infection can diminish blood flow to the area and cause the appendix to burst, which can be extremely dangerous. If the appendix ruptures, the contents can spread into the abdomen, resulting in a severe infection.
• Testicular Torsion - Testicular torsion is a medical emergency requiring immediate medical attention that occurs when the spermatic cord twists, leading to a loss of blood flow to the testicle. According to the AAP, 30-40% of all cases of testicular torsion result in loss of the testicle.
• Abdominal Injury - Blunt injury accounts for almost 90% of abdominal trauma in children and can occur in the school setting from falls or athletics. ​​Abdominal organs, including the pancreas, liver, bladder, and most often, the spleen, may be injured, potentially resulting in internal bleeding.

Identifying Acute Abdominal Pain Emergencies

If a student is experiencing severe or persistent abdominal pain, it is important to assess the totality of the symptoms and determine whether or not emergency medical attention is necessary. Here are some signs and scenarios that would require immediate medical attention and emergency care:

• Severe pain that renders the student unable to walk or perform jumping jacks
• Pain that is accompanied by persistent, bilious, or bloody vomiting
• Abdominal examination uncovers a hard, tender, distended abdomen or mass
• Pain that is accompanied by other signs of shock
• Pain that is accompanied by blood in the urine or bloody diarrhea
• Possibility of pregnancy
• Any complaint of scrotal pain, testicular discomfort or concerns
• Pain and abdominal distention that progresses quickly following trauma
• Suspicion of ingestion, overdose, or allergic reaction

Managing Acute Abdominal Pain Emergencies

While waiting for emergency medical services to arrive or transporting the student to the emergency room, there are some steps that you can take to manage the symptoms of acute abdominal pain:

• Do not provide food or fluids until the cause of the abdominal pain has been diagnosed.
• If appendicitis is suspected, avoid applying heat, which can cause perforation.
• Monitor the student's symptoms and report any changes to emergency medical services or the healthcare provider.

Acute abdominal pain can be an excruciating and scary experience for students while presenting a challenging assessment situation for school nurses. By identifying the symptoms and knowing when to seek emergency medical attention, you can help ensure that your students receive the care they need promptly and effectively.