Abdominal visceral injury is an uncommon but serious form of physical abuse. Most cases of abusive visceral injury are clinically occult and are at risk of going undiagnosed. Current recommendations suggest screening children with suspicious injuries for occult visceral trauma by measuring serum hepatic transaminases and pancreatic enzymes (primarily lipase) and ordering a CT scan of the abdomen for children with an AST or ALT ≥ 80 mmol/L, a lipase ≥ 100 mmol/L or clinical signs of intra-abdominal injury. This approach was proposed to the Child Maltreatment pediatricians at the 2015 Canadian Symposium on Advanced Practices in Child Maltreatment and was informally adopted by several Canadian Child Maltreatment programs.
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