الفهرس 
Acknowledgment
Pathogenesis and etiology of acute abdomenOnly 14 pages are availabe for public view
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Abstract
Acute abdominal pain is one of the most common complaints in childhood, and one that frequently requires rapid diagnosis and treatment in the emergency department. Although acute abdominal pain is typically self-limiting and benign, there are potentially life-threatening conditions that require urgent management, such as appendicitis, intussusception, or bowel obstruction. Meticulous history taking and repeated physical examinations are essential to determine the cause of acute abdominal pain and to identify children with surgical conditions. Ultrasound is a common and efficient aid to clinical and laboratory work-up in a young patient with abdominal pain. Nondiagnostic ultrasound or a diagnostic conundrum was present in a small percentage (3 % of this study) of our patients. CT has a diagnostic merit over ultrasound, especially in surgical cases, but due to the hazards of radiation exposure, should be limited to those cases with genuine diagnostic difficulty. When acute appendicitis is suspected, the possibility of complicated appendicitis as in appendicular mass or abcess,or a perforated appendix should be excluded during the sonographic examination, otherwise plain MDCT is recommended. While in cases where bowel obstruction is suspected clinically CT with contrast is recommended as a first imaging modality. It is mandatory to some extent in these cases. While in cases of acute epigastric pain, US examination and plain X-ray abdominal film is satisfactory to reach the diagnosis of acute pancreatitis and impacted stone in the pancreatic duct. Also in cases were suspected perforated viscus, US examination with plain erect abdominal X-ray film is satisfactory to reach the diagnosis, where CT is recommended to localize the perforation. In cases with acute calcular and acalcular cholechystits were suspected, intrahepatic biliary channel dilatation should be excluded, if not, or if the case was presented by obstructive jaundice, a cause of obstruction should be visualized during the sonographic examination (impacted stone or a mass). Examination with CT is recommended plain if no masses were visualized, and CT with contrast if the presence of a mass is suspected. In cases presented with fever and acute abdomen a good sonographic search for localized inflammatory reaction is recommended if it is negative or inconclusive, CT with contrast is recommended. Regarding acute appendicits: plain MDCT is recommended when appendicular mass or abcess or a perforated appendix is suspected either sonographically or clinically. Regarding bowel obstruction: contrast enhanced MDCT is mandatory in all clinically diagnosed cases. Regarding acute pancreatitis: plain and contrast enhanced MDCT is recommended when pancreatitis of biliary origin is suspected either clinically or songraghically. Regarding perforated viscus: plain MDCT is recommended not only for reaching the diagnosis, but also for localization. Regarding acute cholecystits: plain MDCT is recommended when the patient is presented by obstructive jaundice, or when intrahepatic biliary channel dilatation is suspected sonographically, contrast is added if a soft tissue lesion is suspected sonograghically. Regarding localized abcesses: contrast enhanced MDCT is recommended when it is highly suspected clinically, and cannot be reached sonographicaly. Otherwise, US was proved to be quiet satisfactory as the first imaging modality of acute abdomen, regarding the cost, ionizing radiation hazards, and time consumption.