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

Pain in the abdomen of a child is a cardinal symptom of many sorrows and digestive organs. In young children, the equivalent of pain is anxiety, screaming, rejection of the mother's breast. In children of preschool and primary school age, pain can be manifested by a feeling of rapid saturation and overfilling of the stomach. Reactions to pain in the abdominal cavity are very individual, but in any case the doctor should regard abdominal pain as an objective reality. Pain pulses that arise in the abdominal organs are transmitted along nerve fibers of two types: for fibers of type A, the impulses cause a sensation of acute and clearly localized pain, and for fibers of type C, indefinite dull pain. The afferent neurons of these fibers are in the ganglia of the posterior roots of the spinal cord, and some axons cross the middle line and go back to the cerebellum, middle brain and thalamus. The perception of pain occurs in the postcentral gyrus of the cerebral cortex, which receives impulses from both halves of the body.

The pain that occurs in the organs of the abdominal cavity is felt at the level of the segment from which the affected organ is innervated:

• pain in the epigastric region is observed in the pathology of the diaphragm, the cardiac section of the esophagus, stomach, duodenum, pancreas.
• pains in the right hypochondrium arise mainly in diseases of the liver, biliary tract and gallbladder, head of the pancreas, duodenum, hepatic curvature of the colon, rarely - the omentum and diaphragm.
• pain in the elusive hypochondrium appear with lesions of the stomach, pancreas, splenic flexure of the large intestine, diaphragm, 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, the omentum give pain in the peripodal region.
• Shingles are characteristic of pancreatic lesions.
• pain in the right iliac region can indicate appendicitis, damage to the terminal segment of the ileum, ileocecal angle (Crohn's disease), and also in the syndrome of the mobile cecum.
• in the left ileal region of pain are more often caused by the lesion of the sigmoid colon and may occur in the syndrome of Payra. This disease, first described in 1910, is characterized by painful attacks, a feeling of pressure and fullness in the left hypochondrium. The pain can be irradiated to the interstitial region, accompanied by shortness of breath and palpitations. This pathological condition is caused by transient episodes of gas stagnation and stool in the flexura lienalis area, since the angle in this zone with the long transverse colon can be acute. This, in turn, creates favorable conditions for stagnation. In addition, there is a spasm of the large intestine. Resolving factors are emotional stress, eating foods rich in carbohydrates. It is necessary to find out the periodicity of pain, their connection with food intake and its nature, clarification of pain irradiation; important is the clarification of the nature of the pain syndrome.
• if the distal part of the colon, urinary tract and pelvic organs are concerned, the pain is felt in the suprapubic region.
• diffuse abdominal pain may indicate peritonitis, intestinal obstruction, abdominal hemorrhagic vasculitis, ruptures of parenchymal organs, adhesions; sometimes such pains are observed with expressed ascites and flatulence.

A particular variant of abdominal pain is intestinal colic - an uncomfortable, discomforting, feeling of rasping or squeezing in the abdominal cavity. Intestinal colic is caused by diskinetic phenomena and increased gas production. 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 neuromuscular apparatus of the intestine;
• enzyme deficiency;
• intestinal dysbiosis;
• food allergy;
• irrational feeding.

Typically, colic disappear when optimizing the feeding regimen or selecting an adequate formula.

Dull, pressing pains in the abdomen in children indicate overgrowth or increase in the abdominal organs (gelato and splenomegaly, tumors, cysts, flatulence). Paroxysmal pains are observed with hypertension of smooth muscles - spasm of 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, as a rule, pulling, blunt; on the contrary, very intense pain is characteristic of the defeat of the large intestine.

By the nature of pain in the abdomen are distinguished:

• spasmodic pain
• distensive pain
• adhesive adhesions

Spastic pains occur in colitis, enterocolitis, and often occur as an intestinal colic. Distention pains caused by strong stretching of the intestine with gases and feces are accompanied by bloating. Adhesion pains occur at the height of the peristalsis of the intestine, their appearance is facilitated by sudden movements of the patients, tremors of the body, etc.

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

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