Pediatric abdominal pain due to obstacles? Please accept this guide

time:2022-12-09 author:Sneeze
Pediatric abdominal pain due to obstacles? Please accept this guide

For reference only for medical professionals

Can you think of these 12 causes?

A few days ago at the emergency clinic, an 8-year-old boy sat in a wheelchair with a painful face, and was pushed into the clinic by his grandfather. The child was hunched over and clutching his stomach tightly. His grandfather told him that he had "sudden stomach pain" and "has been in pain for about half an hour" - it turned out to be a case of "acute abdomen". Figure 1: Abdominal pain "acute abdomen" has always been one of the most difficult diseases among the common diseases encountered by emergency physicians, because the abdomen involves many organs and the situation is complex, no matter what kind of blood vessels, nerves and various organs appear It can be expressed as "abdominal pain". For children, because of the inability to accurately describe the condition and the lack of cooperation in physical examination, clinicians have no idea what to do when they encounter children with "abdominal pain". When encountering a child who complains of "abdominal pain" in clinical work, you may wish to start with the following ideas, and beware of the "pits" that can be seen everywhere on the clinical road. Figure 2: Common accompanying symptoms of abdominal pain in children 1. Sore throat and headache may be caused by throat virus and streptococcal infection. The infection of these pathogens can also cause abdominal pain, often with or without fever. During the physical examination, pay attention to the presence of tonsil exudation or redness, swollen anterior cervical lymph nodes, petechiae on the palate, inflammation of the uvula, and scarlet fever-like rash (small red papules). Figure 3: Tonsil exudation 2. Slight swelling of the testis with groin bulge may be strangulated hernia or testicular torsion. Similarly, girls may also have gynecological diseases such as ovarian torsion, dysmenorrhea, and hymen atresia. Ultrasound and abdominal and pelvic CT help to assist in diagnosis. Figure 4: Groin bulge 3. Accompanied by bed-wetting, dysuria, and frequent urination. The smell of urine may be urinary tract infection and calculus. During the physical examination, pay attention to the appearance, smell, and presence of secretions of the perineum. The urine routine is positive for occult blood and white blood cells. Elevation or urine culture can help in diagnosis. Note that ultrasonography has limited diagnostic capabilities for urolithiasis below 5 mm and for sediment-like urinary calculi. Fourth, accompanied by reduced defecation, difficult and dry stool may be constipation. Fecal mass and bezoar impaction often present with left lower abdominal pain, and the left lower abdominal mass can be palpated during physical examination, and ultrasound may assist in the diagnosis. Five, accompanied by abdominal distension, gas, diarrhea may be food allergies, intolerance. Food allergies often occur when eating foods such as seafood, tropical fruits, nuts, or foods that have never been tried before. Food intolerance can occur when excessive intake of foods containing lactose (such as milk, ice cream), fructose (such as apples, peaches), sorbitol (such as pears, prunes, chewing gum and other sweets) can also occur in After excessive intake of foods that are too greasy (such as moon cakes, cream cakes) or difficult to digest (such as persimmons, chestnuts). These foods are often too common, and parents may often struggle to recall or proactively provide these clues without a doctor asking or reminding them. Figure 5: Diarrhea 6. Accompanied by fever and jaundice, it may be viral hepatitis, but children often only have mild abdominal pain without accompanying symptoms such as fever and jaundice. Careful inquiries about vaccination status and contact history should be conducted, and relevant etiology should be conducted. Examination can aid in diagnosis. Figure 6: Viral infection 7. Accompanied by skin rash and joint pain may be allergic purpura (HSP). Abdominal pain often occurs after typical skin rash, and a typical skin rash is found on physical examination, especially when it is mainly on the lower limbs, which can be diagnosed. Figure 7: Typical rash of HSP [1] Eight, accompanied by nausea, headache may be migraine, more common in children over 7 years old, with or without nausea and headache, relieved by rest, family history of migraine can help diagnosis. 9. Accompanied by environmental changes Old and newly renovated living environment may be lead poisoning, often manifested as paroxysmal abdominal pain, may be accompanied by anemia or no other symptoms, often old living environment (such as old-style wall coating, old-style water pipes) ), high-risk occupations for parental lead exposure, all suggest a high risk of lead exposure, and serum blood lead levels of 5 μg/dl can be diagnosed. 10. Accompanying vomiting may be diabetic ketoacidosis (DKA). Children's DKA usually only presents with abdominal pain, with or without vomiting. Therefore, for children with abdominal pain and vomiting, it is necessary to check blood sugar when prescribing supplementary examinations. consciousness. 11. Accompanied by tachycardia, it may be myocarditis. Abdominal referred pain may occur due to liver congestion or pericarditis due to heart failure. Be vigilant when examining unexplained tachycardia. The history of prodromal infection within the past 2 weeks may be As a basis, an electrocardiogram can assist in the diagnosis. 12. An exclusive diagnosis of functional abdominal pain, only abdominal pain, no pain in other parts, and no other symptoms such as fever, rash, diarrhea, weight loss, vomiting, dysphagia or pain, abnormal urination, etc. At the same time, the physical examination is normal, the fecal occult blood test is negative, and abdominal pain is often related to stress (such as school exams, interpersonal relationships, family problems, etc.), before the diagnosis can be made [2]. Summarizing back to the child at the beginning of this article, the author inquired about his accompanying symptoms, diet and stool, etc., and combined with the results of the physical examination to determine that the cause of his abdominal pain was most likely caused by constipation. Then he fully communicated with his grandfather about the condition, and suggested that the grandfather can delay the improvement of the examination, first use Kaisailu to relieve the child's abdominal pain, and then observe whether the child's abdominal pain can be relieved. Grandpa expressed understanding, so he pushed the child out of the clinic. After more than half an hour, the child bounced back to express his gratitude. To sum up, compared with "intussusception", "appendicitis" and other diseases that can be easily diagnosed by conventional ultrasound and other auxiliary examination methods, these "not so" ordinary abdominal pains may be more dependent on the clinician's detailed medical history. Ask to avoid being "pitched". References: [1] [2] Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A , van Tilburg M. Functional Disorders: Children and Adolescents. Gastroenterology. 2016 Feb 15:S0016-5085(16)00181-5. doi: 10.1053/j.gastro.2016.02.015. Epub ahead of print. PMID: 27144632. This article First release: Pediatrics Channel of the Medical Community Author of this article: Xu Lulu of the First Affiliated Hospital of Anhui Medical University Editor in charge: Xiang Yu Illustration source: Taishuai Gallery All the pediatric clinical knowledge doctor station apps you want to see 👇1. Scan the QR code below 2. 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