Abdominal pains in children

Abdominal pain in children is one of the frequent symptoms.

Pains manifestation may be:

acute – if they last for several hours or days (max. 7 days)

chronicle – three or more episodes during the last three months.

Causes of the acute abdominal pains:

• close injury of belly: contusion, hematoma, hemorrhage, perforation of internal organs;
• gastrointestinal:

obstructive process and irritated peritoneum, malrotation, invagination, adhesive obstruction, strangulation of hernia, appendicitis, obstruction due to foreign body, tumor, fecaloma, helminthes;

intraabdominal diseases: infectious gastroenteritis and colitis (viral, bacterial, parasitic), pancreatitis, cholecystitis, hepatitis, peptic disease etc.

extraabdominal diseases: meningitis, pneumonia, streptococci pharyngitis, inflammation of middle ear, myocarditis / pericarditis

metabolic disorders: diabetic ketoacidosis, porphyria, uremia, acute adrenal insufficiency;

systemic diseases: sickle-cell anemia, Henoch-Schonlein disease, Kawasaki disease.

Chronicle abdominal pains:

• gastrointestinal system: chronicle constipation, inflammatory diseases of bowels, parasitic infection (amebiasis, giardiasis), gastroesophageal reflux, Helicobacter pylori infection, celiac disease…
• urogenital system: urinary tracts, urolithiasis, urinary tracts obstruction, ovarian cyst, endometriosis, renal pelvis inflammation, other abdominal epilepsy, violence (physical, emotional, sexual).

Abdominal diagnostics criteria, so called “alarming symptoms”:

• unexpected, sharp abdominal pain, which intensiveness grows hour by hour being accompanied with:
• progressing abdominal swelling;
• hematemesis (bloody vomiting with red or brownish mass) or melena (black, sticky feces);
• intractable vomiting (sometimes mixed with bile or feces);
• signs of shock;
• fever;
• orthostatic hypotension;
• signs of irritation of peritoneum: defense (local rigidity of muscles), local painfulness, Blumberg's symptom
• oliguria;
• delayed defecation or discharge of flatus, loud tummy rumbling or peristalsis arrest, diarrhea;
• later – leukocytosis, neutrophilia, left shift of leukogram, increased EDR

Diagnostic laboratory tests and specialist's consultations

In the most cases, acute abdominal pains may be identified on the ground of anamnesis and physical examination;

first, we should rule out acute surgical pathology. After exclusion of the acute abdomen, step by step gastroenterological and non-gastroenterological pathologies should be ruled out;