ABDOMINAL PAIN

Done by : Dr. Nawras

In pediatric age group

ABDOMINAL PAIN *It is common and challenging compliant

•At least 20% of children will consult a doctor for it bythe age of 15 years

ACUTE CHRONIC

*Child <2 years *Child >2 years

Surgical medical Surgical medical

-Malrotation- volvulus-Intussusceptions‘- appenedcitis--necrotising- entrocoloitis -Incarcerated inguinal hernia

-GE-- UTI--Hepatitis --Pneumonia-- spontaneous bacterial peritonitis

-Appendicitis- IO- M diverticulum- Peritonitis- cholycycstits-HSP- Trauma- incarcerated ingunal hernia

-GE-UTI-Lead poisoning -Non specific abdominal pain-IBD-Hepatitis -Mesenteric lymphadenitis

ACUTECHRONIC

•The presence of at least 3 bouts of pain * severe enough to affect activity

* over a period of at least 3 months

Organic

Functional

CHRONIC ACUTE

*Child <2 years *Child >2 years

- colic

-Malabsorption

-Milk allergy

-- rotational defect

-Hirschsprung dis.

--Esophygitis

-Functional pain

- constipation-Giardiasis

-Intra-abdominal Abscess

-lead poisoning-Pancreatitis

-Abdominal migraine-Epilepsy

-Urolithiasis

Functional

-Abdominal pain without evidence of a pathologic condition

-Usually between 4-14 years.

- the pain usually brief with pain free interval range from days to weeks.

- site :over umbilicus, no radiation - Lab. Ix. Not disclose any abnormality-

Organic

-Localized pain in non-preiumbilical region.

- referred pain.

-Pain awaken the child from sleep.-Sudden onset of severe pain .

-High grade fever-Dysuria-Jaundice

-Anorexia /weight loss-Reduce activity level -Specific physical findings

GENERAL APPROACH to a child with recurrent abdominal pain

•HISTORY : SOCRATES also systemic symptoms :fever ,rash….

•Family Hx. : peptic ulcer , IBD

•EXAMINATION : general : clubbing ,arthritis ,rash•Abdominal : distension ,tenderness, organomegaly , bowel sounds and bruit

GENERAL MANAGMENT•ORGANIC CAUSES should be excluded

• patient with functional abdominal pain don’t need any medication

•Hospitalization and drug therapy may reinforce such pain behavior

•Therapy for : helminthiasis , protozoal infection , H pylori and acid peptic disease is not useful

• severe acute pain may be relieved by anticholinergics

parasitic infestation : Giardia lamblia , Entameba histolytica

PAIN MAY RECUR even after ttt of infestation

GI CAUSES OF PAIN

Acute appendicitis : classical triad of Rt lower abdominal pain , fever , vomiting does not occur in all cases

Retrocecal type : is difficult to be diagnosed ( diarrhea and colicky abdominal pain ) is only the

symptom in these patients

DX. X-ray , US , CT scan also useful

Acute mesenteric lymphadenitis C/F resemble acute appendicitis Hx. Reveal preceding resp. or enteric disease

due to the infxn with YERSINIA pseduotuberculosis

or YERSINIA enterocolitica

Area of tenderness in mesenteric lymphadenitis shifts when the patient is rolled from site to site

obstructive lesion of the gut

Mid gut volvulus

Meckel`s diverticulum SXS :

-Colicky abdominal pain - distension - vomiting-Exaggerated bowel sound

Intussusception

Peptic ulcer :

Its believed to be infrequent In children Acute gastric ulceration : aspirin ,steroid ,potassium chloride ,toxins ,stress ( burns

for ex.) Zollinger Ellison $ gstric > duedenal ( older age >9) Ttt:- Antacids , anticholinergics - H2 receptor blocker , PPI- H. PYLORI : amoxicillin , clarithromycin,

omprazole for 1-2 weeks

GI allergy : diarrhea, N&V , colicky abdominal pain 3 factors contribute to allergy development :- Genetic – allergen exposure – contributory factors Amebic liver abcess SXS : fever, loss of appetite ,Rt

upper abdominal pain . Liver :tender ,enlarged , jaundice is minimal or abcent Ttt : metroniazole 20-50mg/kg/day for 1 week

Passive congestion of liver : in CHF or pericarditisPain & tendress in Rt hypochondrium

Acute pancreatitis * follow mumps , biliary tract disease ,

trauma ,drug Congenital anomilies anf generalized infection

Sand U amalyse are elevated SXS :sudden sever pain ,vomiting , fever,

extreme prostration Ttt: supportivesx. Pancreatic abcess &necrotic pancreatitis .

disorder of GU system :GN,PN, urinary stone HN and ectopic kidney

Ddx in girl . Menstrul cycle ,salpingitis ovarian torsion and hematocolpos

Pain out side the abdomen : basal pneumonia, RF, endocarditis

Metabolic : DKA, lead poisoning

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