acute mesenteric lymphadenitis in children
Introduction
Brief introduction of acute mesenteric lymphadenitis in children Acute mesenteric lymphadenitis (acutemesentericlymphadenitis) is one of the common causes of abdominal pain in children. It is clinically easy to be confused with acute appendicitis. It is more common in children under 7 years old. It is mostly a viral infection, which occurs in the winter and spring, often in the acute upper respiratory tract. After the infection is complicated, or secondary to intestinal inflammation, the typical symptoms are fever, abdominal pain, vomiting, sometimes accompanied by diarrhea or constipation. Acute mesenteric lymphadenitis, also known as acute nonspecific mesenteric lymphadenitis (acutenonspecificmesentericlymphadenitis), by Brenneman (1921) First of all, the general case drug treatment is effective, a small number of mesenteric lymphadenitis after the formation of abscess after suppuration, it requires surgical treatment. basic knowledge The proportion of illness: 15% Susceptible people: children Mode of infection: non-infectious Complications: Intussusception Intestinal obstruction
Cause
Causes of acute mesenteric lymphadenitis in children
Virus infection (35%):
Because the lymphatic drainage of the distal ileum is very rich, the ileum, large lymph nodes in the large intestine, upper respiratory tract infection or intestinal infection, viruses, bacteria and their toxins along the blood circulation to the lymph nodes of the area, causing mesenteric lymphadenitis, the virus infected by the mesentery Lymph node hyperplasia, edema, congestion, but culture was negative.
Bacterial infection (30%):
Mesenteric lymphadenitis caused by Salmonella infection is different from viral lymphadenitis. The lymph nodes invaded by bacteria are mostly acute inflammation in the lymph nodes, hemorrhage and necrosis, and Salmonella can be isolated in the lymph nodes.
Pathogenesis
Pediatric mesenteric lymph nodes are widely distributed along the mesenteric artery and its arterial arch. The end of the ileum and the ileocecal area are particularly common. The contents of the small intestine often stay at the end of the ileum due to the action of the ileocecal valve, so the intestinal bacteria and virus products are easy to be Absorbed.
Prevention
Prevention of acute mesenteric lymphadenitis in children
1. Mesenteric lymphadenitis is mostly a viral infection, often complicated by acute upper respiratory tract infection, or secondary to intestinal inflammation, so usually pay attention to prevent colds and fever and pay attention to diet.
2. Enhance physical fitness and improve self-immunity: pay attention to work and rest, participate in physical exercise, and eat more fresh fruits and vegetables rich in vitamins. Mesenteric lymphadenitis is mostly a viral infection, often complicated by acute upper respiratory tract infections, or secondary to intestinal inflammation. Therefore, usually pay attention to prevent colds and fever and pay attention to diet.
Complication
Complications of acute mesenteric lymphadenitis in children Complications, intussusception, intestinal obstruction
It is often a complication of upper respiratory tract infection. Because children have vomiting and eating less, water and electrolyte disorders are common. Some patients may have intussusception and intestinal obstruction.
1. Electrolyte disorders Some common symptoms: fatigue, muscle cramps, weakness, irritability, nausea, dizziness, confusion, fainting, irritability, vomiting, dry mouth. Less peeing is one of the most common symptoms of electrolyte imbalance. The patient may have no awareness of urinating for more than 7-8 hours. In addition, the following are symptoms that can be observed with severe electrolyte imbalance: coma, slow heart rate, seizures, palpitations, hypotension, and lack of coordination of limbs.
2. Intussusception refers to the insertion of a segment of the intestine into the lumen of the intestine and causes the contents of the intestine to pass through the barrier. Intussusception accounts for 15% to 20% of intestinal obstruction, and there are two types of primary and secondary. Primary intussusception occurs mostly in infants and young children. Secondary intussusception is more common in adults. The largest intussusception is the insertion of the proximal intestine into the distal intestine. The reverse intussusception is rare and inferior to the total. 10% of the number of cases.
3. Intestinal obstruction (ileus) means that the contents of the intestine are blocked in the intestine. For common acute abdomen, it can be caused by a variety of factors. At the beginning of the disease, the intestinal segment of the obstruction has anatomical and functional changes first, followed by the loss of body fluids and electrolytes, intestinal wall circulatory disorders, necrosis and secondary infections. Toxicemia, shock, death. Of course, if diagnosed in time, active treatment can mostly reverse the development of the disease, resulting in cure.
Symptom
Acute mesenteric lymph node inflammation in children Common symptoms Right lower quadrant pain Abdominal muscle tension Cervical lymphadenopathy Abdominal pain with diarrhea Sore throat Lower abdominal rebound pain constipation
Typical manifestations are sore throat, burnout discomfort after upper respiratory tract infection, followed by fever, abdominal pain, vomiting, sometimes accompanied by diarrhea or constipation. About 20% of the sick children have cervical lymphadenopathy, and abdominal pain is the earliest symptom of the disease. It can be in any part, but because the lesion mainly invades a group of lymph nodes in the terminal ileum, it is common in the right lower abdomen. The nature of abdominal pain is not fixed. It can be manifested as dull pain or spastic pain. It feels better in two pain intervals. The most sensitive tender parts may be different for each physical examination. The tenderness is close to the midline or high. It is not fixed like acute appendicitis, and the degree is milder than acute appendicitis. There is little rebound tenderness and abdominal muscle tension. The lower right abdomen and the small nodular mass with tenderness are enlarged mesenteric lymph nodes. Some patients may have intestinal obstruction. It should be observed that younger children have clinical symptoms similar to appendicitis, but the condition For patients with milder and no abdominal muscle tension, acute mesenteric lymphadenitis should be considered. Generally, abdominal pain can be significantly improved after fasting, intravenous infusion, antibiotics, etc., without surgery. Sometimes it is difficult to identify with appendicitis. If the symptoms are not improved, it should be surgically explored. When the child develops fever, abdominal pain, vomiting and upper respiratory tract infection, or occurs after intestinal inflammation, no abdominal muscle tension should be Consider acute mesenteric lymphadenitis.
The characteristics of this disease:
1. Most of them are complicated by upper respiratory tract infection or intestinal infection, and have clinical manifestations of fever, abdominal pain and vomiting.
2. Abdominal pain is common in right lower quadrant pain, which is paroxysmal, spastic pain, rebound tenderness and abdominal muscle tension are rare.
3. Abdominal tenderness is not fixed and can change with body position changes.
4. Ultrasound examination showed mesenteric lymphadenopathy.
5. Diagnosis of this disease needs to be differentiated from acute appendicitis, intestinal peristalsis, intestinal ascariasis and other acute abdomen.
6. After anti-inflammatory, anti-viral treatment, the prognosis is good.
Examine
Examination of acute mesenteric lymphadenitis in children
After the onset, the white blood cells can be normal or slightly elevated. The pathological manifestations are lymph node hyperplasia, edema, and congestion. However, the culture is often negative, and the urine and urine are normal. Ultrasonography shows abdominal mesenteric thickening and multiple mesenteric lymph nodes. The size is not equal, mostly located in the right lower abdomen, its shape is smooth and complete, the cortex and medulla is clear, and it has a low echo. The echo inside is even, and a small amount of liquid dark area is visible in the abdominal cavity.
Diagnosis
Diagnosis and diagnosis of acute mesenteric lymphadenitis in children
diagnosis
According to experience, children with high fever in upper respiratory tract infections or intestinal infections, abdominal pain should consider the possibility of complicated mesenteric lymphadenitis, and early abdominal B-ultrasound can confirm the diagnosis, prevent misdiagnosis of the disease, help to correctly handle Condition, guide treatment, improve efficacy.
Differential diagnosis
Diagnosis of acute mesenteric lymphadenitis requires exclusion of bowel hyperactivity, intestinal ascariasis and other causes of abdominal pain.
1. Acute appendicitis: the symptoms are similar, but acute mesenteric lymphadenitis is mild, and the onset is slow. Typical appendicitis patients have metastatic right lower abdominal pain, fixed tenderness and rebound tenderness in the right lower abdomen, and abdominal muscle tension. , the total number of white blood cells and neutrophils increased.
2. Tuberculous mesenteric lymphadenitis: slow onset, in addition to abdominal pain, fever, often have night sweats, weight loss, loss of appetite and other symptoms of tuberculosis, accompanied by other parts of tuberculosis infection, tuberculin test or tuberculosis antibodies, etc. For identification.
3. Infectious mononucleosis: mesenteric lymphadenopathy may also occur, but often accompanied by cervical lymphadenopathy, splenomegaly, examination of atypical lymphocytes, cold agglutinin, EB virus titer, etc. are conducive to diagnosis.
