Acute abdomen in children
1/Why acute abdomen in children want to present ??!!!
2/Areal case discussion in dibba hospital .
3/Evaluation of acute abdominal pain clinically .
4/Intussusception
5/Cases .
6/Something missed in my topic . ?????
For info log on to www.healthlibrary.com. Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar
Abdominal Pain in children occurs commonly. Sometimes it is nothing to do worry about but sometimes it can be life threatening. To identify and treat early is necessary in all children.
acute abdominal pain in pediatrics. include background and approach also there are three cases included, intussusception, Hirschsprung's disease and DKA.
Acute abdomen in children
1/Why acute abdomen in children want to present ??!!!
2/Areal case discussion in dibba hospital .
3/Evaluation of acute abdominal pain clinically .
4/Intussusception
5/Cases .
6/Something missed in my topic . ?????
For info log on to www.healthlibrary.com. Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar
Abdominal Pain in children occurs commonly. Sometimes it is nothing to do worry about but sometimes it can be life threatening. To identify and treat early is necessary in all children.
acute abdominal pain in pediatrics. include background and approach also there are three cases included, intussusception, Hirschsprung's disease and DKA.
This presentation describes the total and partial intestinal atresia, its clinical features and diagnosis. in addition, this presentation include the definition of esophageal atresia, its classification, diagnosis and treatment.
acute abdomen conditions in radiology and their evaluation
acute pancreatitis, cholicystitis, pelvic pathology, mri evaluation , intra abdominal abcess, plain radiography evaluation of acute abdomen, vascular causes of acute abdomen, causes of acute abdomen.
This presentation describes the total and partial intestinal atresia, its clinical features and diagnosis. in addition, this presentation include the definition of esophageal atresia, its classification, diagnosis and treatment.
acute abdomen conditions in radiology and their evaluation
acute pancreatitis, cholicystitis, pelvic pathology, mri evaluation , intra abdominal abcess, plain radiography evaluation of acute abdomen, vascular causes of acute abdomen, causes of acute abdomen.
Abdominal pain is pain that occurs between the chest and pelvic region. Abdominal pain can be crampy, achy, dull, intermittent or sharp. It 's also called a stomachache. Inflammation or diseases that affect the organs in the abdomen can cause abdominal pain.
C H A P T E R 3
Abdominal pain
Abdominal pain is a subjective feeling of discomfort in the abdomen that can be caused by a variety of
problems. The goal of initial clinical assessment is to distinguish acute lifethreatening conditions from
chronic/recurrent or acute mild, selflimiting conditions. Assessment is complicated by the dynamic rather than
static nature of acute abdominal pain, which can produce a changing clinical picture, often over a short period
of time. In addition, both children and older adults tend to deviate from the usual and anticipated clinical
pattern of abdominal pain. The following three processes can produce abdominal pain: (1) tension in the
gastrointestinal (GI) tract wall from muscle contraction or distention, (2) ischemia, and (3) inflammation of the
peritoneum. Pain can also be referred from within or outside the abdomen.
Colic is a type of tension pain. It is associated with forceful peristaltic contractions and is the most
characteristic type of pain arising from the viscera. Colicky pain can be produced by an irritant substance, from
infection with a virus or bacteria, or by the body’s attempt to force its luminal contents through an obstruction.
Another type of tension pain is caused by acute stretching of the capsule of an organ, such as the liver, spleen,
or kidney. The patient with this visceral pain is restless, moves about, and has difficulty getting comfortable.
Ischemia produces an intense, continuous pain. The most common cause of intestinal ischemic pain is
strangulation of the bowel from obstruction.
Inflammation of the peritoneum usually begins at the serosa covering the affected and inflamed organ,
causing visceral peritonitis. The pain is a poorly localized aching. As the inflammatory process spreads to the
adjacent parietal peritoneum, it produces localized parietal peritonitis. The pain of parietal peritonitis is more
severe and is perceived in the area of the abdomen corresponding to the inflammation. A patient with parietal
pain usually lies still and does not want to move.
Pain can be referred from within the abdomen or from other parts of the body (Box 3.1).
Box 3.1
S o m e C a u s e s o f P a i n P e r c e i v e d i n A n a t o m i c a l R e g i o n s
Right upper quadrant
• Duodenal ulcer
• Hepatitis
• Hepatomegaly
• Pneumonia
• Cholecystitis
Right lower quadrant
• Appendicitis
• Salpingitis
• Ovarian cyst
• Ruptured ectopic pregnancy
• Renal or ureteral stone
• Strangulated hernia
• Meckel diverticulitis
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0003-print-1560441994.xhtml 6/13/2019
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0003-print-1560441994.xhtml
• Regional ileitis
• Perforated cecum
Periumbilical
• Intestinal obstruction
• Acute pancreatitis
• Early appendicitis
• Mesenteric thrombosis
• Aortic aneurysm
• Diverticulitis
Left upper quadrant
• Ruptured spleen
• Gastric .
C H A P T E R 3
Abdominal pain
Abdominal pain is a subjective feeling of discomfort in the abdomen that can be caused by a variety of
problems. The goal of initial clinical assessment is to distinguish acute lifethreatening conditions from
chronic/recurrent or acute mild, selflimiting conditions. Assessment is complicated by the dynamic rather than
static nature of acute abdominal pain, which can produce a changing clinical picture, often over a short period
of time. In addition, both children and older adults tend to deviate from the usual and anticipated clinical
pattern of abdominal pain. The following three processes can produce abdominal pain: (1) tension in the
gastrointestinal (GI) tract wall from muscle contraction or distention, (2) ischemia, and (3) inflammation of the
peritoneum. Pain can also be referred from within or outside the abdomen.
Colic is a type of tension pain. It is associated with forceful peristaltic contractions and is the most
characteristic type of pain arising from the viscera. Colicky pain can be produced by an irritant substance, from
infection with a virus or bacteria, or by the body’s attempt to force its luminal contents through an obstruction.
Another type of tension pain is caused by acute stretching of the capsule of an organ, such as the liver, spleen,
or kidney. The patient with this visceral pain is restless, moves about, and has difficulty getting comfortable.
Ischemia produces an intense, continuous pain. The most common cause of intestinal ischemic pain is
strangulation of the bowel from obstruction.
Inflammation of the peritoneum usually begins at the serosa covering the affected and inflamed organ,
causing visceral peritonitis. The pain is a poorly localized aching. As the inflammatory process spreads to the
adjacent parietal peritoneum, it produces localized parietal peritonitis. The pain of parietal peritonitis is more
severe and is perceived in the area of the abdomen corresponding to the inflammation. A patient with parietal
pain usually lies still and does not want to move.
Pain can be referred from within the abdomen or from other parts of the body (Box 3.1).
Box 3.1
S o m e C a u s e s o f P a i n P e r c e i v e d i n A n a t o m i c a l R e g i o n s
Right upper quadrant
• Duodenal ulcer
• Hepatitis
• Hepatomegaly
• Pneumonia
• Cholecystitis
Right lower quadrant
• Appendicitis
• Salpingitis
• Ovarian cyst
• Ruptured ectopic pregnancy
• Renal or ureteral stone
• Strangulated hernia
• Meckel diverticulitis
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0003-print-1560441994.xhtml 6/13/2019
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0003-print-1560441994.xhtml
• Regional ileitis
• Perforated cecum
Periumbilical
• Intestinal obstruction
• Acute pancreatitis
• Early appendicitis
• Mesenteric thrombosis
• Aortic aneurysm
• Diverticulitis
Left upper quadrant
• Ruptured spleen
• Gastric ...
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2. Abdominal pain in a child is one of the most common
presentation with both benign and life-threatening
etiologies , The majority of pediatric abdominal
complaints are relatively benign
-it comprises 2-4% of pediatric visits.
-At least 20% of children seek attention for chronic
abdominal pain by the age of 15 years.
-Up to 28% of children complain of abdominal pain
at least once per week and only 2% seek medical
attention
3. HISTORYHISTORY
-Location: have child use one finger to locate the pain.
-Quality: pain can be a sharp stabbing pain (i.e.
trauma) or diffuse, poorly, localized pain (i.e. chronic
or visceral pain)
-Radiation
-Timing/Onset: onset of the pain, duration of pain,
course during the day, does it wake them at night,
and the frequency of episodes
4. -Alleviating Factors: anything that reduces the pain –
body position, movements medications.
-Aggravating Factors: body position, movements,
relation to food intake.
-Associated Symptoms: can include hematemesis,
vomiting, nausea, hematochezia, melena, diarrhea,
fever, and weight loss.
5. Red flag signs includeRed flag signs include::
Bilious vomiting
Bloody stool or emesis
Night time waking with abdominal pain
Hemodynamic instability
Weight loss
Fever
Jaundice
6. Physical examinationPhysical examination
ABCs; vitals; and growth parameters (is there
evidence of failure to thrive).
Inspection: look for contour, symmetry,
pulsations, peristalsis, vascular irregularities,
skin markings, wall protrusions (hernias), any
signs of trauma (ie. bruising, swelling), and
abdominal distension
Auscultation: auscultate before palpation in the
abdominal exam, listen for bowel sounds,
abdominal bruits
7. Physical examinationPhysical examination
Percussion: assess general tone (tympanic vs
non-tympanic), percuss for liver span and
spleen tip,
Palpation: assess tenderness with light and
deep palpation, assess for guarding and
rebound tenderness, palpate for liver, spleen,
kidney and abdominal masses
Digital rectal exam: first exam the anus for
fissures and skin tags, then assess for tone,
stool, and blood
8. Types of pain :Types of pain :
1- Visceral pain1- Visceral pain
by unmyelinated ( C-fibers ) are located in
the mesentery, Pain is stimulated by ,
peristalis , excessive contraction, stretching,
tension or ischemia of the walls of viscera,
the capsule of a solid organ (liver, spleen,
kidney ) , caused by infection, toxins
(bacterial or chemical agents), ulceration,
inflammation, or ischemia. resulting in dull
poorly localized pain
9. Painful stimuli originating in the liver,
pancreas, biliary tree, stomach, or upper
bowel are felt in the epigastrium
Pain from the distal small bowel, cecum,
appendix, or proximal colon is felt at the
umbilicus
and pain from the distal large bowel, urinary
tract, or pelvic organs is usually suprapubic.
10. 22--somatic Painsomatic Pain
usually well localized. When the inflamed
viscus comes in contact with the somatic
organ like the parietal peritoneum or the
abdominal wall ,muscle , facia , skin
is transmitted through A-delta fibers which
are myelinated , it cause sharp, and well
localized pain It exacerbated by movement
or cough
11. 33--reffered painreffered pain
pain from extraintestinal locations, from
shared sensory pathway at same level in
spinal cord
Pain in cardiac referred to left shoulder , arm
Pain in stomach referred to retrosternal region
Pain in liver and pancreas to epigastric area
Pain of gall blader to below right scapula
13. Some signs and symptoms maySome signs and symptoms may
suggest Acute surgicalsuggest Acute surgical
conditioncondition
Acute excruciating pain
diffuse severe tenderness on examination,
bilious vomiting
Involuntary - guarding, a rigid voluntary wall, and
rebound tenderness.
14. If these signs present mayIf these signs present may
suggestsuggest
Intestinal perforation (ruptured appendicitis, peptic
ulcer(
Peritonitis
Intussusception
Volvulus
Ruptured spleen
Ovarian or testicular torsion
Strangulated hernia
Ruptured aortic aneurysm
15. If surgical emergency signs not present soIf surgical emergency signs not present so
according to positionaccording to position
1- upper abdomen1- upper abdomen::
Consider:
Ultrasound
Amylase
Lipase
LFTs
Chest x-ray
24. Chronic or recurrentChronic or recurrent
abdominal painabdominal pain
Is abdominal pain for at least 3 months , pain
enough to cause limitaion of activity
Consider:
Urinalysis
CBC
ESR
ALT, amylase, lipase
25. If no Signs and symptoms of an organic etiology
present so :
Functional abdominal pain
Functional dyspepsia
26. Some clues may help to reachSome clues may help to reach
diagnosisdiagnosis::
Functional abdominal pain :
children who have chronic (≥2 months)
abdominal pain, no alarm findings normal
physical examination and lab findings and no
organic etiology present
27. Irritable bowel syndrome Intermittent cramps,
diarrhea, and constipation
Nonulcer dyspepsia Peptic ulcer–like symptoms
without abnormalities on evaluation of the upper
GI tract
28. Chronic constipation Hx of stool retention,
evidence of constipation on examination
Lactose intolerance and Excess fructose or
sorbitol ingestion Symptoms may be associated
bloating, gas, cramps, and diarrhea
29. If Signs and symptoms ofIf Signs and symptoms of
an organic etiology presentan organic etiology present::
30. 11--Weight loss ±DiarrheaWeight loss ±Diarrhea
Consider:
CBC
ESR/CRP
Albumin
Tissue transglutaminase
Stool for occult blood
KUB
UGI/SBFT
Endoscopy
