Abdominal pain in a child: causes, symptoms, diagnosis, treatment

Abdominal pain in a child is a cardinal symptom of many diseases of the digestive organs. In small children, the equivalent of pain is anxiety, crying, refusal to breastfeed. In preschool and primary school children, pain can manifest itself as a feeling of rapid satiety and overflow of the stomach. Reactions to abdominal pain are very individual, but in any case, the doctor must assess abdominal pain as an objective reality. Pain impulses arising in the abdominal organs are transmitted along two types of nerve fibers: along type A fibers, impulses cause a sensation of sharp and clearly localized pain, and along type C fibers - an indefinite dull pain. Afferent neurons of these fibers are located in the ganglia of the posterior roots of the spinal cord, and some axons cross the midline and ascend to the cerebellum, midbrain and thalamus. Perception of pain occurs in the postcentral gyrus of the cerebral cortex, which receives impulses from both halves of the body.

Pain arising in the abdominal organs is felt at the level of the segment from which the affected organ is innervated:

• pain in the epigastric region is observed in pathologies of the diaphragm, cardiac part of the esophagus, stomach, duodenum, pancreas.
• Pain in the right hypochondrium occurs mainly in diseases of the liver, bile ducts and gall bladder, head of the pancreas, duodenum, hepatic curvature of the colon, and less often - the omentum and diaphragm.
• Pain in the left hypochondrium occurs with lesions of the stomach, pancreas, splenic flexure of the colon, diaphragm, and left lobe of the liver.
• The distal part of the small intestine, the cecum with the appendix, the entire proximal half of the large intestine, the mesenteric lymph nodes, and the omentum cause pain in the umbilical region.
• Girdle pain is typical for damage to the pancreas.
• pain in the right iliac region may indicate appendicitis, damage to the terminal section of the ileum, ileocecal angle (Crohn's disease), and also with the syndrome of a mobile cecum.
• in the left iliac region, pain is most often caused by damage to the sigmoid colon and can also occur with Payr's syndrome. This disease, first described in 1910, is characterized by painful attacks, a feeling of pressure and fullness in the left hypochondrium. The pain can radiate to the interscapular region, accompanied by shortness of breath and palpitations. This pathological condition is caused by transient episodes of stagnation of gas and feces in the flexura lienalis region, since the angle in this zone with a long transverse colon can be acute. This, in turn, creates favorable conditions for stagnation. In addition, spasm of the large intestine is noted. Resolving factors are emotional stress, eating food rich in carbohydrates. It is necessary to clarify the periodicity of pain, their connection with food intake and its nature, clarify the irradiation of pain; clarification of the nature of the pain syndrome is of no small importance.
• If the distal colon, urinary tract and pelvic organs are affected, pain is felt in the suprapubic region.
• Diffuse abdominal pain may indicate peritonitis, intestinal obstruction, abdominal hemorrhagic vasculitis, ruptures of parenchymatous organs, adhesions; sometimes such pain is observed with severe ascites and flatulence.

A particular type of abdominal pain is intestinal colic - an unpleasant, uncomfortable feeling of sloshing or squeezing in the abdominal cavity. Intestinal colic is caused by dyskinetic phenomena and increased gas formation. The diagnosis of "intestinal colic" is made if the total duration of colic is 2-3 hours per day. Most often, intestinal colic is the prerogative of infants and is caused by the following factors:

• functional immaturity of the intestinal neuromuscular apparatus;
• enzyme deficiency;
• intestinal dysbiosis;
• food allergies;
• irrational feeding.

Colic usually disappears when the feeding regimen is optimized or when an adequate milk formula is selected.

Dull, pressing pain in the abdomen in children indicates overstretching or enlargement of the abdominal organs (gelato- and splenomegaly, tumors, cysts, flatulence). Paroxysmal pain is observed with hypertonicity of smooth muscles - spasm of the pylorus, sphincter of Oddi, intestinal sphincters; the most pronounced piercing, so-called dagger pains indicate perforating and penetrating ulcers, acute peritonitis, acute intestinal obstruction. In diseases of the small intestine, pain is usually nagging, dull; on the contrary, very intense pain is characteristic of damage to the large intestine.

Depending on the nature of abdominal pain, there are:

• spastic pains
• distension pain
• adhesive pain

Spastic pains occur in colitis, enterocolitis and often proceed as intestinal colic. Distension pains, caused by strong stretching of the intestines by gases and feces, are accompanied by bloating. Adhesive pains occur at the height of intestinal peristalsis, their appearance is facilitated by sudden movements of patients, body shaking, etc.

A burning sensation is observed when the mucous membrane of the upper digestive tract is damaged.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]