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Differential Diagnoses — Acute Abdomen in Childhood The differential diagnoses vary greatly depending on the child's age: Newborns (0-28 days): • Necrotizing enterocolitis (NEC) • Volvulus due to malrotation ⚠️ surgical emergency • Meconium ileus (suspect cystic fibrosis) • Intestinal atresia / stenosis Infants (1-12 months): • Intussusception (ileocecal) — most common cause! • Incarcerated inguinal hernia • Pyloric stenosis (typically 3rd-6th week) Toddlers (1-5 years): • Appendicitis (increasingly from approx. 3 years) • Intussusception • Meckel's diverticulum • Gastroenteritis with complications School-age children/adolescents: • Appendicitis — most common surgical cause! • Testicular torsion (boys!) — always rule out • Ovarian cyst torsion (girls) • Constipation (common, but diagnosis of exclusion) Red Flags (immediate surgical consultation): 🔴 Bilious vomiting 🔴 Bloody stool + colicky pain 🔴 Guarding / board-like abdomen 🔴 Absent bowel sounds Source: AWMF Guideline Acute Abdomen in Childhood, 2023

Structured Case Presentation — Oral KP In the German Medical License Exam (KP), a structured approach is expected. Present as follows: 1. History (systematic): "First, I would take a targeted history: onset, location, and character of pain, accompanying symptoms such as vomiting, changes in bowel habits, fever, urinary complaints. In adolescent girls: menstrual history." 2. Examination (verbalize aloud): "I inspect the abdomen, auscultate all four quadrants, palpate starting from the pain-free area. I check for guarding, rebound tenderness, and palpate the hernial orifices. In boys: do not forget testicular palpation." 3. Differential diagnoses (by probability): "In an 8-year-old child with periumbilical pain radiating to the right lower quadrant, I primarily think of appendicitis. Differentially to consider: mesenteric lymphadenitis, gastroenteritis, and in girls, an ovarian cyst." 4. Diagnostics: "I order: complete blood count with CRP, urinalysis, abdominal ultrasound. If findings are unclear: clinical re-evaluation after 4-6 hours." 💡 Examiner Tip: ALWAYS verbalize your thoughts. The examiners assess your clinical reasoning process, not just the final answer.