Pain in the abdomen of a child

There are at least 85 causes of abdominal pain in children, but there is rarely a problem of finding the exact cause to establish a fairly rare and accurate diagnosis. Most often it is necessary to decide the question: is there an organic disease or does the abdominal pain arise as a result of emotional stress or some other physiological factor?

Only 5-10% of children hospitalized for abdominal pain determine the organic nature of the disease, but even in this case stress is very important (for example, when it comes to the peptic ulcer). When conducting differential diagnostics at the initial stage, Apley's aphorism may be very useful: the further from the navel the abdominal pain is localized, the more likely it is of organic origin. However, children often find it difficult to pinpoint where the abdomen hurts, so some other information about the causes of pain may be more reliable. For example, the answers of a sick child to a doctor's question: "When did you feel pain in your stomach?" Most often these are: "When I had to go to school"; "When I realized that I was walking along the wrong street." Or the answers to the doctor's question: "Who was with you when the pain began?" "What (or who) reduced the pain"? Other history data suggesting a possible diagnosis can also be identified. For example, a very hard feces suggests that the cause of abdominal pain may be constipation.

• The children of the Negroid race should be suspected of sickle cell anemia. It is necessary to make an appropriate test.
• In children from Asian families, tuberculosis is possible - it is necessary to make a Mantoux reaction.
• In children with a tendency to eat inedible things (perverted appetite), it is advisable to examine the blood for the maintenance of lead in it.
• Abdominal migraine should be suspected if the pains are of a periodical nature, accompanied by vomiting, and especially in cases where there is a corresponding family anamnesis. These children can try to appoint meterazin, 2.5-5 mg every 8 hours inside.

Most of the abdominal pains are due to gastroenteritis, urinary tract infection, viral diseases (for example, tonsillitis, combined with nonspecific mezadenitis) and appendicitis. The pancreatitis in case of epidemic parotitis, diabetes mellitus, intestinal involution, intestinal invasion, Meckelian diverticulum, pelvic ulcer, Hirschsprung disease, Shenlaine-Henoch purpura and hydronephrosis are somewhat less likely cause. In older girls, menstruation and salpingitis may be the cause of abdominal pain.

Boys always need to exclude a testicle.

Examination of patients.

Always need to examine the urine and send it to the crop. Other studies - a survey image of the abdominal cavity, a clinical blood count with a leukocyte count, ESR, intravenous urography, a study with a barium enema.

Reflux esophagitis. The disease can manifest as regurgitation, apnea, pneumonia, weight loss, anemia. From the point of view of diagnosis, the determination of pH in the esophagus is more reliable than X-ray studies with barium. Treatment: it is necessary to feed the baby in sitting position, the head end of the crib should be slightly raised, it is not recommended to tighten (swaddle) the baby and feed him with fatty foods. Medicines, such as antacids and sodium-magnesium alginate ("Infant Gaviscon)", available in sachets and in a single dose, may be needed. The contents of one sachet are mixed with 15 ml of chilled boiled water and give the infant a teaspoonful after each breast feeding. If the child is on artificial feeding, the dose of the drug is diluted in a mixture for feeding. Children whose body weight exceeds 4.5 kg should be given a double dose (ie, the contents of two packets).

Bloating

Causes. There are several causes of abdominal distention in children.

Air

• Fecal obstruction
• Ingestion of air
• Malabsorption

Ascites

• Nephrosis
• Hypoproteinemia
• Cirrhosis of the liver
• Congestive heart failure

Dense tumor formation

• Neuroblastoma
• Wilms tumor
• Tumors of the adrenal gland

Cysts

• Polycystic kidney disease
• Liver cysts, dermoid cysts
• Pancreatic cysts

Hepatomegaly. Its causes are also diverse. Infections: many, for example infectious mononucleosis, cytomegalovirus infection.

Malignant neoplasms: leukemia, lymphoma, neuroblastoma.

Metabolic diseases: Gaucher's disease and Hurler, cystinosis, galactosemia.

Other causes: sickle-cell anemia, other hemolytic anemia, porphyria.

Splenomegaly. The reasons are the same as for hepatomegaly, except neuroblastoma.

Neuroblastoma. This high-grade tumor originates from primitive neuroblasts of the sympathetic nervous system. Occurs with a frequency of 1: 6000-1: 10000. It manifests itself, as a rule, by an increase in the volume of the abdomen. Non-iroblastoma may occur in a child of any age, but the prognosis is more favorable (even with spontaneous remissions) in children younger than one year (25% of cases) and in those children who develop the disease in the first and second stages of development. The tumor metastasizes into lymph nodes, scalp, bones (causing pancytopenia and osteolytic bone lesions). In 92% of patients, urinary excretion of catecholamines (vanillin-homdalic and homovanilic acids) increases. Treatment: excision (if possible) and chemotherapy (cyclophosphamide or doxorubicin).

[1], [2], [3], [4], [5], [6], [7]