Recurrent abdominal pain in children
Introduction
Introduction to recurrent abdominal pain in children Recurrent abdominal pain (RAP) is a symptom diagnosis, generally refers to paroxysmal abdominal pain, at least 3 episodes within 3 months. When the episode is severe, it can affect the normal activities of children, while in the intermittent period, the performance is normal. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: pediatric malnutrition
Cause
Causes of recurrent abdominal pain in children
(1) Causes of the disease
There are many causes of abdominal pain, and the symptoms should be distinguished, and the digestive tract should be functional and organic.
1. Symptoms: Mostly caused by extraintestinal diseases, such as respiratory infections, suppurative tonsillitis, liver, biliary diseases, urinary diseases, intestinal parasitic diseases can cause abdominal pain, intestinal parasites used to be abdominal pain The most common cause, intestinal parasitic diseases have been significantly reduced in recent years due to improved diet, especially in cities.
2. Intra-abdominal organic diseases such as ulcer disease, appendicitis, intestinal obstruction, acute abdomen and so on.
3. Functionality: The most common causes are improper diet, snacks, cold drinks, constipation, and abdominal pain caused by digestive disorders (also known as functional dyspepsia).
4. Spirituality: There are also reports in foreign countries that are related to psychological factors in children, such as nervousness and depression.
5. Chronic gastritis and Helicobacter pylori infection: Recent studies suggest that recurrent abdominal pain is associated with chronic gastritis and Helicobacter pylori infection, such as Beijing Fuxing Hospital through fiberoptic gastroscopy in 76 cases of recurrent abdominal pain, found digestive tract mucosal lesions 47 Cases (25 cases of superficial gastritis, 2 cases of reflux gastritis, 2 cases of erosive gastritis, 3 cases of gastric mucosal prolapse, 10 cases of duodenitis, 1 case of esophagitis, superficial gastritis plus duodenitis 4 cases) accounted for 61.84%, ulcer disease in 13 cases, accounting for 17.1%, Helicobacter pylori positive in 33 cases, accounting for 43.4%; Shanghai Ruijin Hospital for 26 cases of non-ulcer dyspeps gastroscopy and pathological examination found superficial gastritis in 25 cases, Superficial atrophic gastritis in 1 case.
(two) pathogenesis
The abdominal organs themselves are not sensitive to pain, and abdominal pain can occur in three main forms:
1. Colic: Mostly caused by muscle spasm or obstruction of tubular organs (simultaneous with sputum), such as intestinal tube, bile duct and ureteral fistula or obstruction, mostly manifested as paroxysmal colic.
2. dull pain: caused by the involvement of the organ capsule, such as the liver, kidney, appendix and peritoneal inflammation caused by the swelling of the capsule, mostly manifested as persistent dull pain, the pain site is more consistent with the site of the organ lesion.
3. Mobility pain: Visceral pain is transmitted to the corresponding spinal cord segment through the visceral sensory nerve, so that the part of the body innervation that enters the same segment feels pain. For example, the pain of the liver and gallbladder can sometimes radiate to the right shoulder. In addition, outside the abdomen Organ pain can sometimes be radiated to the abdomen, such as large leaf pneumonia. Herpes zoster can cause heavier abdominal pain when it invades the abdominal spinal nerve. The abdominal cramps of tetanus can also cause severe abdominal pain.
The mechanism of intestinal fistula caused by digestive dysfunction is that the indigestible food is fermented in the intestine, the gas stimulation stimulates the intestinal wall, or the parasympathetic nerve is excited, causing transient intestinal wall muscle spasm, temporarily blocking the passage of intestinal contents, so The proximal intestinal tube undergoes strong contraction and motility disorder. As the peristalsis strengthens, the abdominal pain is aggravated and the bowel sounds are hyperthyroidism. In severe cases, vomiting can be caused at the same time. After a certain period of time, the intestinal wall muscles are naturally relaxed and abdominal pain. Temporary relief, and then recurrence, typical cases of intestinal fistula often occur in the small intestine, abdominal pain is mainly umbilical, distal large intestine and ileum spasm, colic more radiation to the right lower abdomen, descending colon or sigmoid colon, colic Often appear before the stool, a small number of children with sputum can occur in the colonic liver or spleen, colic is mainly ribs, more common in one side, according to the author's observation, recurrent abdominal pain, the child complained that 4/5 occurred in In the umbilical part, 1/5 occurred in the upper abdomen. The short-term acute authors were mostly intestinal fistulas. The chronically repeated authors were chronically repeated. They were found by gastroscopy, barium meal or electrogastrogram. There are gastric lesions, of which superficial gastritis is the most common, followed by duodenitis, a few are ulcer disease, and the positioning of abdominal pain in children, especially infants, is very inaccurate.
Prevention
Prevention of recurrent abdominal pain in children
Because of the psychological or physiological factors involved, but also affected by environmental, family, genetic and other factors, so preventive focus, including eliminating concerns, try to avoid simple symptomatic drug treatment, prevent constipation, develop regular bowel habits, avoid mental stress, etc. Effective prevention of functional RAP, prevention and treatment of peptic ulcer disease, digestive tract inflammation, parasitic infection, etc., can prevent and treat RAP.
Complication
Complications of recurrent abdominal pain in children Complications, malnutrition in children
Repeated episodes can cause malnutrition in children and growth retardation.
Symptom
Symptoms of recurrent abdominal pain in children Common symptoms Paroxysmal abdominal pain Abdominal tenderness Abdominal pain Facial pale bloating Children crying Uneasy ileocecal insufficiency
The location and nature of clinical manifestations of abdominal pain mainly depend on the child's complaints. During the physical examination, the children should cooperate to check whether there is tenderness, muscle tension or mass. The older children have little problem and can cooperate. The younger ones often cannot cooperate. At this time, it is necessary to rely on sudden abnormal crying, pale, sweating, poor spirit and special posture to judge, it is best for children who do not cooperate to use the contrast method for abdominal examination, the mother is teasing to make the child not Crying, or feeding by the mother, the doctor touches the stomach from the side or back with a gentle hand, the movement should be gentle and slow, so that the child is accustomed to this kind of examination, and then repeatedly compare the reaction of each part, such as still crying and not cooperating, can Give chloral hydrate once orally, dose: 30 ~ 50mg / kg each time (10% solution 0.3 ~ 0.5ml / kg each time), oral or enema, dilute with water when enema, until the child sleeps and then check.
At the same time, it is necessary to understand the digestive symptoms of the child's diet, vomiting and stool, which can help to determine the cause, such as intestinal fistula caused by improper eating and digestive disorders. The child presents with sudden onset of paroxysmal abdominal pain. The duration is not long, from a few minutes to tens of minutes, when the pain is timed, every day or every few days, most of the abdominal pain is mild, often occurs during meals, after a while, the past play as usual, severe performance Crying and irritating, rolling and sweating, even pale and cold hands and feet, check at the time of onset, most abdominals have no positive signs, a few can show mild tenderness in the abdomen, or seem to have muscle tension, but the attack in the past, intermittent full abdominal soft, no It has tenderness, no intestinal type, no mass, and occasionally can touch the intestines of the strips, often with abdominal distension and bowel sounds.
Examine
Examination of recurrent abdominal pain in children
1. Stool routine: Check for indigestion and parasite eggs and occult blood tests.
2. Peripheral blood: Check leukocytes and classify as necessary to exclude inflammatory infections.
3. X-ray examination: abdominal plain film to observe intestinal swelling and free gas, if necessary, do a meal or barium enema to observe the presence of ulcers, gastritis, duodenitis, intestinal adhesions, intestinal obstruction or diverticulum.
4. Gastroscopy: Gastroscopic examination of chronic recurrent abdominal pain can help to find comprehensive pathological changes such as gastritis, duodenitis, ulcer disease and so on.
5. Electrogastrogram examination: Because the non-invasive examination is easy to accept, the results are not specific and can only be used as a reference.
6. Helicobacter pylori examination: There is a close relationship between chronic recurrent abdominal pain, such as the discovery that Helicobacter pylori should be treated.
7. Gastric dynamics examination: esophageal and duodenal manometry, real-time ultrasound, gastric emptying test, help to find digestive tract dysmotility.
Diagnosis
Diagnosis and differential diagnosis of recurrent abdominal pain in children
The main diagnosis is based on recurrent abdominal pain, and there is a lack of abnormal signs during the interictal period. The history of past episodes is helpful for diagnosis.
It is important to first exclude organic diseases, especially easy to be confused with surgical acute abdomen, should pay attention to identification, common diseases such as biliary ascariasis, intestinal mites, appendicitis, intussusception, and less common intestines Reversal, intestinal perforation, pancreatitis, incarcerated hernia, congenital intestinal malrotation, biliary fistula, cholangitis, kidney stones, small choledochal cyst abdominal pain and ileal distal diverticulum abdominal pain should be carefully identified, and some Medical diseases can also cause heavier abdominal pain, such as the onset of large leaf pneumonia, acute heart failure leads to rapid liver enlargement, etc. The abdominal pain of allergic purpura is actually caused by diarrhea in the gastrointestinal mucosa, which stimulates the intestinal wall to cause intestinal fistula. The appearance of skin purpura is easy to distinguish from simple intestinal fistula, but it should be noted that the intestinal fistula of purpura can sometimes be intussusception, can not be ignored, but also pay attention to the small intestines of small infants after repeated attacks for a few days, can suddenly develop into intestines Stack, occasionally abdominal tetanus, clinical manifestations of spastic abdominal pain, which is due to abdominal muscle spasm rather than intestinal fistula, its treatment is completely different from prognosis and intestinal fistula, Need to pay attention to abdominal epilepsy, manifested as sudden onset of abdominal cramps in the umbilical cord, sometimes in other parts, lasting for several minutes to several hours, abdominal examination is normal, and EEG has epileptic waves, sometimes abdominal pain is caused by mental factors Trauma and panic.
