bloating in children
Introduction
Introduction to bloating in children Abdominal distention, that is, abdominal distension, may be caused by gas in the intestine, abdominal cavity, effusion, massive mass in the abdomen or weakness of the abdominal muscles. Infants with abdominal distension are most common in bloating. Children with acute or chronic illness, abdominal augmentation high out of the chest, severe abdominal distension can affect breathing, can not supine. Clinically, a light abdominal examination can make the pneumoperarrhea softer, while the intestinal flatulence can touch the intestine. basic knowledge The proportion of illness: 90% Susceptible people: young children Mode of infection: non-infectious Complications: constipation, nausea and vomiting
Cause
Causes of abdominal distension in children
Physical factors (30%):
Physical factors include the accumulation of large amounts of gas or liquid in the digestive tract of the body. May cause gastrointestinal motility disorders due to inflammation of the gastrointestinal tract. Excessive gas or liquid builds up in the abdominal cavity.
Disease factors (25%):
The disease factor refers to abdominal swelling caused by other diseases in the body, such as a large cystic mass or solid mass in the abdomen. Abdominal muscle weakness. Pediatric ascites in children causes abdominal swelling.
Other factors (20%):
Children with abdominal distension are mostly mainly inflated.
Prevention
Pediatric bloating prevention
1. Eat foods that are easy to produce gas in the stomach and intestines:
Such as potatoes, sweet potatoes, pasta, sugar, etc., are easy to produce gas in the stomach, and finally lead to abdominal distension.
2, do not eat non-digestible food:
Hard food such as fried beans and hard pancakes is not easy to digest, and it stays longer in the gastrointestinal tract, which may cause more gas to cause bloating.
3. Develop good eating habits:
Change the habit of gorging, because eating too fast, or eating while walking, easy to bring in a lot of air; commonly used straw drink will also let a lot of air sneak into the stomach, causing bloating.
4. Prevent bad emotions:
Unpleasant emotions such as anxiety, anxiety, sadness, depression, depression, etc. may weaken digestive function or stimulate the stomach to produce too much stomach acid.
5, enhance physical fitness, moderate fiber supplement food:
Pay attention to exercise, pay attention to work and rest, and insist on proper outdoor exercise every day, not only helps to overcome bad emotions, but also helps the digestive system maintain normal function. High-fiber foods sometimes have the effect of reducing bloating, especially after eating high-fat foods, eating more fresh fruits and vegetables rich in vitamins.
6, prevention of gastrointestinal disorders:
For some conditions, bloating or aura, or one of the symptoms, such as allergic enteritis, ulcerative colitis and so on.
Complication
Pediatric bloating complications Complications constipation nausea and vomiting
It varies depending on the primary disease. Can appear nausea, vomiting, bowel sounds hyperthyroidism, constipation and so on.
Intestinal sounds are hyperactive:
When the intestinal peristalsis is enhanced, the number of bowel sounds increases and the bowel sounds are loud and high, and even a clanging sound or a metal sound is called hyperthyroidism, which is seen in mechanical intestinal obstruction. In this type of patient, the intestinal lumen is enlarged, the intestinal wall is swollen and thin, and it is extremely tense. It can resonate with the hyperactive bowel sounds, so that the metallic tone of sorghum can be heard in the abdomen.
In the physical examination, the lower right abdomen can usually be used as the auscultation point of the bowel sound. Under normal circumstances, the bowel sounds are about 4-5 times per minute, and the frequency, sound and pitch variation are large, and the meal is frequent and obvious. The rest is sparse and weak, and it is only by the experience of the examiner to judge whether it is normal.
Symptom
Pediatric bloating symptoms, common symptoms, bloating, bloating, bloating, abdomen, abdomen, bloating
First, clinical manifestations:
Children with acute or chronic illness, abdominal augmentation high out of the chest, severe abdominal distension can affect breathing, can not supine.
There are two cases of bloating, generally flatulence, but a few are pneumoperitoneum. In these two cases, in addition to the standing X-ray examination of the underarms, the clinical abdominal abdomen can be puffed. It is softer, and the flatulence in the intestine can touch the shape of the intestine.
Second, related inspections:
1. Abdominal examination:
Slightly rubbing the abdomen, the drum sound is gas, the real sound is a solid mass, the actual sound also has conductive tremor as effusion, abdominal auscultation mechanical bowel obstruction when the bowel sounds hyperthyroidism, paralytic ileus hinder the bowel sounds weakened or disappear.
2, clinical physical examination:
Clinical physical examination of bloating in children is very important. Through careful and meticulous clinical examinations, it is often possible to make a rough diagnosis of the disease or to find a way to further assist the examination. On the contrary, it may miss the diagnosis and misdiagnosis, causing damage or even life-threatening to the child.
Examine
Pediatric bloating examination
The following checks are possible to confirm the diagnosis:
First, blood routine:
Various infections caused by abdominal distension can be seen as infectious blood, increased erythrocyte sedimentation rate, positive blood culture, and increased acute phase protein.
Can be used for B-ultrasound, barium enema, X-ray standing photo or fluoroscopy, see the multiple intestines in the small intestine and contracture of the colon can be diagnosed as mechanical intestinal obstruction; paralytic intestinal obstruction can be seen in the colonic inflation; see intestinal tube floating in Ascites is characterized by ascites.
Second, routine radiology examination
1. Abdominal plain film:
Abdominal plain film should be the first choice for the diagnosis of pneumoperitoneum.
In addition to suggesting intestinal obstruction in different parts, it may also indicate the size and location of abdominal occupying lesions.
Abdominal plain film is also easy to show the meridian peritonitis and neuroblastoma with different characteristics of calcification and teratoma skeletal shadow and suggest diagnosis.
2, gastrointestinal angiography:
(1) Meal:
The size and location of the intra-abdominal space-occupying lesions were determined by barium meal.
(2) Barium enema:
In children with intestinal obstruction, the presence or absence of gas in the colon can be observed by barium enema to determine whether the obstruction is complete. Pelvic masses and rectal lesions may also be diagnosed by barium enema.
3, urography:
(1) Intravenous pyelography (IVP):
Often used to diagnose congenital malformations or tumors of the urinary system, such as hydronephrosis and diagnosis of nephroblastoma.
(2) Retrograde cystography:
It is most important for diagnosing urethral valve, ureteral cyst and bladder tumor.
Third, CT examination:
Through this examination, not only the size of the tumor can be measured, but also the mass is determined to be solid and cystic, and the thickness of the capsule wall and the approximate properties of the capsule contents are determined. CT examinations often also indicate that the mass is derived from an organ or shows its relationship to the surrounding organs.
Fourth, B-ultrasound:
Color Doppler can show the blood supply and vascular system morphology of the organs, and can indicate the direction and speed of blood flow, which is unique compared with CT.
Diagnosis
Diagnosis and diagnosis of bloating in children
diagnosis
How to make a correct diagnosis through clinical physical examination, necessary laboratory and imaging examination, and then appropriate and timely treatment is the basic skill that every pediatrician must master.
1, looking at the diagnosis: for the clinical physical examination of children with abdominal distension first and important steps.
(1) Range of abdominal distension:
Need to determine whether it is full abdominal distension, middle abdominal distension, lower abdominal distension, left or right bloating, or limited to a certain area of bloating.
(2) Degree of bloating:
The degree of bloating should be judged according to the physiological characteristics of children in different age groups. In addition, children of all ages can have abdominal distension after a full meal, which is temporary, and should be identified.
(3) Gastrointestinal motility:
Peristalsis can be expressed as gastric, intestinal and peristaltic waves, indicating that there may be obstruction in the distal digestive tract. It should be noted that neonates and severe malnourished children may have faint bowel type in the absence of digestive tract obstruction due to weak abdominal wall.
2, palpation:
The middle layer palpation may further determine the cause and nature of abdominal distension, especially for the diagnosis of abdominal mass, such as the tension of cystic mass, the texture of solid mass and the smoothness of the surface. You can also understand the relationship between the tumor and certain organs. If you can master the diagnosis, it will be very helpful. It is difficult for children with general abdominal distension to perform deep palpation.
3, percussion:
It is often determined by percussion examination whether the bloating is caused by a gas, a liquid or a solid.
4, auscultation:
For the determination of digestive tract obstruction is the most important mechanical or paralytic, combined with other signs and auxiliary examination to estimate the extent of mechanical intestinal obstruction.
5, anal diagnosis:
The anus can not be discarded when the lesion is suspected to be in the lower abdomen or pelvis. It is also known by anal examination that whether there is stool or gas in the rectum to determine whether the intestinal obstruction is complete.
Differential diagnosis
First, the gas in the gastrointestinal tract:
1. Internal medicine:
Children's organs and systems are in the developmental stage, their functions are still imperfect, they are highly dependent on the outside world, and they are prone to diseases due to external influences. Internal bloating is generally not associated with gastrointestinal type, abdominal tenderness and muscle tension. Abdominal distension with vomiting of a large amount of bile or hematemesis, blood in the stool should pay attention to the surgical situation.
2, surgical:
Surgical diseases lead to abdominal flatulence is the most common cause of digestive tract obstruction caused by various reasons, in the early postpartum, often occur in various parts of the congenital digestive tract malformation, especially the most common atresia and stenosis. Some diseases are functional intestinal obstructions (such as congenital megacolon) caused by abnormal development of the nervous system.
Second, ascites, blood abdomen, pneumoperitoneum, abdominal infection:
1, ascites:
Ascites refers to the presence of excess free fluid in the abdominal cavity. There are a small amount of free fluid in the abdominal cavity of normal people, and these fluids are in the dynamic balance of normal metabolism. If the dynamic balance is unbalanced for some reason, the volume of the peritoneal fluid is too much, and ascites is formed.
2, blood abdomen or bloody ascites:
Internal organs (especially substantial organs) damage or rupture of blood vessels often cause bleeding, and blood accumulation in the abdominal cavity is called blood belly. Abdominal exudation caused by strangulated intestinal obstruction caused by various reasons is often bloody, which is caused by increased intravascular pressure and increased permeability of blood vessel wall. Hemorrhagic necrotic enteritis not only has bloody ascites, but also discharges bloody stools with a special odor.
3, pneumoperitoneum:
Pneumoperitoneum refers to the presence of gas in the abdominal cavity. Because normal people should not have any gas in the abdominal cavity, it is generally said that pneumoperitoneum is a pathological state, and most of them are caused by perforation of the digestive tract, and a small part is an infection of the abdominal cavity or intestinal gas-producing bacteria.
4, abdominal infection:
Abdominal infection is a common condition in pediatric surgery. The most common type of abdominal infection in children is acute appendicitis. Neonatal necrotizing enterocolitis and primary peritonitis that occurs in school-age girls are also typical abdominal infections.
Third, abdominal masses and tumors
1, organ swelling:
It is most common for the liver and spleen to enlarge, and the degree of enlargement is similar to the localized abdominal distension. It should be differentiated, such as liver enlargement and spleen enlargement.
2, solid mass:
It is not uncommon for children to see a solid tumor in the abdomen. According to their nature, they can be divided into congenital dysplasia, tumor and inflammatory mass.
3. Cystic masses and tumors:
Abdominal cystic masses are even more than solid masses, and most are associated with congenital factors. According to the source of its occurrence, it is most related to the urinary system.
