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;

indications for hospitalization and laboratory and instrumental examinations;

examinations should be provided according to age and supposed diagnosis!

Treatment

After précising of diagnosis, management of the diseases causing acute abdominal pains is provided according to the appropriate recommendations.

Pediatrician Dalila Tsivadze