Date post: | 14-Aug-2015 |
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Health & Medicine |
Upload: | drnawras |
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ABDOMINAL PAIN
Done by : Dr. Nawras
In pediatric age group
ABDOMINAL PAIN *It is common and challenging compliant
•At least 20% of children will consult a doctor for it bythe age of 15 years
ACUTE CHRONIC
*Child <2 years *Child >2 years
Surgical medical Surgical medical
-Malrotation- volvulus-Intussusceptions‘- appenedcitis--necrotising- entrocoloitis -Incarcerated inguinal hernia
-GE-- UTI--Hepatitis --Pneumonia-- spontaneous bacterial peritonitis
-Appendicitis- IO- M diverticulum- Peritonitis- cholycycstits-HSP- Trauma- incarcerated ingunal hernia
-GE-UTI-Lead poisoning -Non specific abdominal pain-IBD-Hepatitis -Mesenteric lymphadenitis
ACUTECHRONIC
•The presence of at least 3 bouts of pain * severe enough to affect activity
* over a period of at least 3 months
Organic
Functional
CHRONIC ACUTE
*Child <2 years *Child >2 years
- colic
-Malabsorption
-Milk allergy
-- rotational defect
-Hirschsprung dis.
--Esophygitis
-Functional pain
- constipation-Giardiasis
-Intra-abdominal Abscess
-lead poisoning-Pancreatitis
-Abdominal migraine-Epilepsy
-Urolithiasis
Functional
-Abdominal pain without evidence of a pathologic condition
-Usually between 4-14 years.
- the pain usually brief with pain free interval range from days to weeks.
- site :over umbilicus, no radiation - Lab. Ix. Not disclose any abnormality-
Organic
-Localized pain in non-preiumbilical region.
- referred pain.
-Pain awaken the child from sleep.-Sudden onset of severe pain .
-High grade fever-Dysuria-Jaundice
-Anorexia /weight loss-Reduce activity level -Specific physical findings
GENERAL APPROACH to a child with recurrent abdominal pain
•HISTORY : SOCRATES also systemic symptoms :fever ,rash….
•Family Hx. : peptic ulcer , IBD
•EXAMINATION : general : clubbing ,arthritis ,rash•Abdominal : distension ,tenderness, organomegaly , bowel sounds and bruit
GENERAL MANAGMENT•ORGANIC CAUSES should be excluded
• patient with functional abdominal pain don’t need any medication
•Hospitalization and drug therapy may reinforce such pain behavior
•Therapy for : helminthiasis , protozoal infection , H pylori and acid peptic disease is not useful
• severe acute pain may be relieved by anticholinergics
parasitic infestation : Giardia lamblia , Entameba histolytica
PAIN MAY RECUR even after ttt of infestation
GI CAUSES OF PAIN
Acute appendicitis : classical triad of Rt lower abdominal pain , fever , vomiting does not occur in all cases
Retrocecal type : is difficult to be diagnosed ( diarrhea and colicky abdominal pain ) is only the
symptom in these patients
DX. X-ray , US , CT scan also useful
Acute mesenteric lymphadenitis C/F resemble acute appendicitis Hx. Reveal preceding resp. or enteric disease
due to the infxn with YERSINIA pseduotuberculosis
or YERSINIA enterocolitica
Area of tenderness in mesenteric lymphadenitis shifts when the patient is rolled from site to site
obstructive lesion of the gut
Mid gut volvulus
Meckel`s diverticulum SXS :
-Colicky abdominal pain - distension - vomiting-Exaggerated bowel sound
Intussusception
Peptic ulcer :
Its believed to be infrequent In children Acute gastric ulceration : aspirin ,steroid ,potassium chloride ,toxins ,stress ( burns
for ex.) Zollinger Ellison $ gstric > duedenal ( older age >9) Ttt:- Antacids , anticholinergics - H2 receptor blocker , PPI- H. PYLORI : amoxicillin , clarithromycin,
omprazole for 1-2 weeks
GI allergy : diarrhea, N&V , colicky abdominal pain 3 factors contribute to allergy development :- Genetic – allergen exposure – contributory factors Amebic liver abcess SXS : fever, loss of appetite ,Rt
upper abdominal pain . Liver :tender ,enlarged , jaundice is minimal or abcent Ttt : metroniazole 20-50mg/kg/day for 1 week
Passive congestion of liver : in CHF or pericarditisPain & tendress in Rt hypochondrium
Acute pancreatitis * follow mumps , biliary tract disease ,
trauma ,drug Congenital anomilies anf generalized infection
Sand U amalyse are elevated SXS :sudden sever pain ,vomiting , fever,
extreme prostration Ttt: supportivesx. Pancreatic abcess &necrotic pancreatitis .
disorder of GU system :GN,PN, urinary stone HN and ectopic kidney
Ddx in girl . Menstrul cycle ,salpingitis ovarian torsion and hematocolpos
Pain out side the abdomen : basal pneumonia, RF, endocarditis
Metabolic : DKA, lead poisoning
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