Abdominal pain is a for the use of...

Abdominal pain is a for the use of all problem in children. Although most numerous children with acute abdominal pain have self-limited conditions, the pain may herald a surgical or medical turn of events The most difficult challenge is making a timely diagnosis likewise that treatment can be initiated and morbidity hindered This article provides a comprehensive clinical guideline for the evaluation of the child with acute abdominal pain.

Pathophysiology

Clinically, abdominal pain falls into three categories: visceral (splanchnic) pain, parietal (somatic) pain, and referr pain.

Visceral pain arises when noxious stimuli affect a viscus, like as the stomach or intestines. Tension, stretching, and ischemia stimulate visceral pain fibers. Tissue congestion and inflammation take care of to sensitize nerve endings and lower the outset for stimuli. Because visceral pain fibers are bilateral and unmyelinated and chronicle the spinal cord at multiple of the same heights visceral pain usually is inanimate poorly localized, and felt in the midline. Pain from foregut formations (e.g., lower esophagus, stomach) generally is felt in the epigastrium. Midgut forms (e.g., small intestine) cause periumbilical pain, and hindgut forms (e.g., large intestine) cause lower abdominal pain.

Parietal pain arises from noxious stimulation of the parietal peritoneum. Pain resulting from ischemia, inflammation, or stretching of the parietal peritoneum is transmitted [i]or[/i] part of to the other myelinated afferent fibers to specific dorsal base ganglia on the same side and at the same dermatomal flat as the origin of the pain. Parietal pain usually is sharp, intense, discrete, and localized, and coughing or emotion can aggravate it.

Referr pain has many of the characteristics of parietal pain further is felt in remote areas supplied through the same dermatome as the diseased organ. It eventuates from shared central pathways for afferent neuron from different sites. A classic example is a patient with pneumonia who at hands with abdominal pain because the T9 dermatome distribution is shared from the lung and the abdomen. (1)

Etiology

Table 1 lists many causes of acute abdominal pain in children. Information forward rare entities can be lay the foundation of in a standard pediatric surgery textbook (2)

INFANTILE COLIC

Infantile colic affects 10 to 20 percent of infants during the first three to four weeks of life. Typically, infants with colic scream, draw their knee up against their abdomen, and appear to be in harsh pain. (3)

GASTROENTERITIS

Gastroenteritis is the chiefly common cause of abdominal pain in children. (4) Viruses like as rotavirus, Norwalk virus, adenovirus, and enterovirus are the greatest in number frequent causes. (4,5) The most numerous common bacterial agents include Escherichia coli, Yersinia, Campylobacter, Salmonella, and Shigella.

APPENDICITIS

Appendicitis is the greatest in quantity common surgical condition in children who current with abdominal pain. (2,6) Approximately individual in 15 persons develop appendicitis. (7) Lymphoid tissue or a fecalith interrupts the appendiceal lumen, the appendix becomes distended, and ischemia and necrosis may bring to maturity Patients with appendicitis classically near with visceral, vague, poorly localized, periumbilical pain. Within six to 48 hours, the pain becomes parietal as the overlying peritoneum becomes inflamed; the pain then becomes well localized and constant in the right iliac fossa.

MESENTERIC LYMPHADENITIS

Mesenteric lymphadenitis frequently is associated with adenoviral infection. The condition mimics appendicitis, reject the pain is more diffuse, signs of peritonitis frequently are absent, and generalized lymphadenopathy may be present

CONSTIPATION

Acute constipation usually has an organic cause (eg gastroenteritis, appendicitis), while chronic constipation usually has a functional cause (eg low-residue diet). Abdominal pain resulting from constipation is most numerous often left-sided or suprapubic.

ABDOMINAL TRAUMA

Abdominal trauma can be accidental or intentional. dull abdominal trauma is more usual than penetrating injury. Abdominal trauma may cause musculocutaneous injury, bowel perforation, intramural hematoma, laceration or hematoma of the liver or blue devils and avulsion of intra-abdominal organs or vascular pedicles.

INTESTINAL OBSTRUCTION

Intestinal obstruction bring into views a characteristic cramping. Causes of intestinal obstruction include volvulus, intussusception, incarcerated hernia, and postoperative adhesions.

PELVIC INFLAMMATORY DISEASE

Pelvic inflammatory disease (PID) usually is caused by way of Chlamydia trachomatis or Neisseria gonorrhoeae. (7) Risk factors include multiple sexual partners, use of an intrauterine device (IUD), and a history of PID.

Clinical Evaluation

In evaluating children with abdominal pain, a thorough history is required to identify the greatest in number likely cause. An initial evaluation of the history is followed by means of a physical examination and a reassessment of certain points of the history. An algorithm is at handed in Figure 1. (8)

HISTORY

Age of attack Age is a key factor in the evaluation of abdominal pain (Table 2) (79-11)