Abdominal pain in children Causes of abdominal pain

Abdominal pain in children

Causes of abdominal pain 1 -Acute abdominal pain Sudden onset of abdominal pain that requires urgent evaluation for serious medical or surgical condition 2 -Chronic or recurrent abdominal pain It is abdominal pain that occurs each month for at least 3 consecutive months

Acute abdominal pain Causes A-Medical causes 1 -Acute abdominal infection n Streptococcal pharyngitis n Acute gastroenteritis n Acute pyelonephritis n Acute pancreatitis and peritonitis n Acute hepatitis

2 -Acute systemic diseases n Henoch- schonlein purpura n DKA n Lower lobe pneumonia n Acute rheumatic fever n Sickle cell disease n Malignancy

B-Surgical causes n n n Acute appendicitis Intussusception and volvulus Incarcerated inguinal hernia Cholecystitis and renal stone Impacted fecal masses

Dignosis of acute abdominal pain n n n 1 -History Decrease appetite and activity Vomiting(contianed blood or bile) Associated with fever or not Bowel movement(constipation or diarrhea) Intermittent pain—biliary obstruction Diffuse, constant , increased with movement---peritonitis

2 -Physical examination General; restlesseness suggests colicky pain Site of pain; around umbilicus—functional Tenderness or rigidity—surgical condition Exaggerated bowel sounds then diminished ----–intestinal obstruction

3 -Investagtion n n CBC, blood sugar, electrolytes, ABG Urine analysis Abdominal X ray Abdominal ultrasound

Chronic abdominal pain n Causes 1 -Functional(70 -90%) 2 -Organic (10 -30%)

Functional Abdominal Pain n Nonorganic abdominal pain or functional abdominal pain refers to pain without evidence of anatomic, inflammatory, metabolic, or neoplastic abnormalities

Because the exact etiology and pathogenesis of the pain are unknown and because no specific diagnostic markers exist, a diagnosis of functional abdominal pain often is a diagnosis of exclusion

Irritable bowel syndrome ◦ Functional abdominal pain associated with alteration in bowel movements Abdominal migraine ◦ Functional abdominal pain with features of migraine (paroxysmal abdominal pain associated with anorexia, nausea, vomiting or pallor as well as maternal history of migraine headaches)

Functional Organic Site of pain Periumbilical Away from umbilicus Severity Vague and not severe Maye be severe and awake child from sleep Other compliants Absent Weight loss, fever, diarrhea, rectal bleeding Apperance Healthy Look ill Abdominal sign None Tenderness, rigidity, organomegaly

Mangment of Functional Abdominal Pain 1 -Exclusion of organic causes by history, physical examination and investigations n 2 -Treatment by Reassurance of patient. n

Organic causes n n n n constipation, carbohydrate malabsorption musculoskeletal pain parasitic infection peptic disorders (eg, reflux esophagitis, gastric and duodenal ulcers) H. pylori infection. Food allergy 15

Gallbladder and pancreas n Cholelithiasis n Choledochal cyst n Recurrent pancreatitis Genitourinary tract n UTI n Hydronephrosis n Urolithiasis

Diagnosis of organic pain 1 -History—growth failure 2 -Physical examination n n Pain away from umbilicus Awakening the child at night Lion pain with urinary symptoms Marked after milk ingestion—Lactose intolerance

n n n n Laboratory Investigation 1 -According to suspected cause 2 -CBC, blood sugar, electrolytes, ABG 3 -Urine analysis 4 -Abdominal X ray 5 -Abdominal ultrasound 6 -CT abdomen