Pediatric Abdominal Pain at Pediatric Clinic DRHC Dubai

• Pediatric Abdominal pain is the most frequent gastrointestinal complaint that brings a child to a physician. The majority of pediatric abdominal complaints are relatively benign (e.g., constipation), but it is important to pick up on the cardinal signs that might suggest a more serious underlying disease.
• Diagnosing abdominal pain in children is a challenging task.

ACUTE ABDOMINAL PAIN (Last hours to days)

Acute abdominal pain in children may be the result of:

• Extra-abdominal disease (e.g., lower lobe pneumonia; pharyngitis)
• Intra-abdominal disease (acute gastroenteritis; hepatitis; gastritis; pancreatitis; UTI; intestinal obstruction;  hernias and masses)
• Metabolic ( ketotic acidosis)
• Hematologic cause (sickle cell crises)
• Genitourinary problems (testicular torsion, ovarian cyst, ovarian torsion, ectopic pregnancy for adolescent girls.
• Surgical cases (intussusception; appendicitis; intestinal obstruction; and hernias)

A good history and physical examination are very important to detect the cause and can guide the physician to perform the appropriate investigations for final diagnosis and treatment.

History

• Location of the pain and quality (localized; generalized; dull; sharp; colic pain)
• Radiation, severity, and timing of pain.
• Alleviating factors and aggravating factors.
• Associated symptoms (vomiting; constipation; diarrhea; melena; weight loss;  jaundice and testicular pain)
• Dietary history
• Family history
• Female (menstruation cycle)

Physical Examination

• Vital signs
• Growth parameters
• General examination
• Abdominal examination: palpation; auscultation; and percussion
• Digital rectal examination

After history and physical examination, it is very important to identify the surgical cases for abdominal pain that need immediate surgical intervention. Red flag signs include:

• Bilious vomiting
• Abdominal distention
• Rigidity and rebound in abdominal examination.
• Bloody stool or emesis
• hemodynamic instability

Common Differential Diagnosis For Abdominal Pain

• CONSTIPATION – infrequent bowel evacuation or painful defecation. Blood can be seen in the stool from an anal fissure.
• GASTROENTERITIS - abdominal pain, diarrhea, vomiting, fever. (can be bacterial or viral etiology)
• ACUTE APPENDICITIS – right lower abdominal pain, fever, anorexia, vomiting, can rupture and lead to sepsis.
• Trauma – history of trauma or signs of bruising.
• URINARY TRACT INFECTION – dysuria, frequency, and hematuria.
• ACUTE TONSILLITIS: STREPTOCOCCAL AND MESENTERIC LYMPHADENITIS
• PNEUMONIA (LOWER LOBE) – tachycardia, tachypnea, fever, chest and abdominal pain.
• DYSMENORRHEA

Less Common Cause

• Intussusception – colicky pain; fever; lethargy; vomiting; peak incidence in age 6m
• Meckel's diverticulum – similar presentation of appendicitis
• Mesenteric adenitis
• Small bowel obstruction
• Volvulus
• Hernias
• Viral hepatitis
• Acute pancreatitis
• Splenic infarction
• Nephrolithiasis
• Testicular torsion
• Ovarian torsion
• Ruptured ovarian cyst
• Ectopic pregnancy
• Pelvic inflammatory disease
• Cholecystitis

Investigations

• Complete Blood Count
• Erythrocyte Sedimentation Rate
• Urinalysis
• Stool analysis
• Cultures
• Amilase or lipase
• Abdominal ultrasound
• CT scan
• Abdominal Xray
• According to the history and physical examination can help to establish the diagnosis.

TREATMENT: It depends on the cause of abdominal pain.

Chronic Abdominal Pain

Chronic abdominal pain in children is defined as pain for more than 2 weeks in duration and or recurrent pain for more than 3 episodes of pain, which is severe enough to affect activity within 3 months.

Causes

1. Irritable Bowel Syndrome:
   • Isolated recurrent abdominal pain or associated with dyspepsia or altered bowel pattern, nausea, vomiting, satiety, constipation, or diarrhea, and or alternating periods of both.
   • The symptoms have a functional basis. Disorders such as fears, nocturnal enuresis, and sleep disturbance are seen in 30% of affected children.
   • Social factors such as: new teacher, new school, stress, parental pressure for achievement, are associated with attacks of pain.
   • Antispasmodic medication is used for the relief of pain.
2. Constipation:
   • It is a major cause of chronic abdominal pain.
   • It is treated with laxatives and a fiber diet to resolve the recurrent pain.
3. Peptic disorder:
   • Esophagitis, gastritis, gastric and duodenal ulcer, H pylori infection.
   • The child presents with chronic epigastric pain, early satiety, and nausea.
   • Endoscopic investigation is generally indicated for treatment with H2 receptor blockers, proton pump inhibitors, and erythromycin, Flagyl for H pylori infections.
4. Abdominal migraine:
   • Periodic nausea, vomiting, and abdominal pain that last 6-8 hours with intervals of weeks or months, with no symptoms or signs. Treatment is usually with antiemetics or migraine medications.
5. Lactose Intolerance:
   • Abdominal pain: bloating, after mild consumption.
   • Diagnosis: Hydrogen breath test after lactose ingestion, and the treatment is a free lactose diet.
6. Inflammatory Bowel Disease:
   • Ulcerative colitis; Crohn's disease, lower abdominal pain, fever, weight loss, fatigue, joint pain, rashes, hematochezia, diarrhea, and recurrent mouth ulceration.
   • Barium enema and colonoscopy are indicated for diagnosis.
   • Treatment with prednisolone, a special diet, and sometimes surgical intervention.
7. Familial Mediterranean fever:
   • Recurrent fever, abdominal pain, joint pain, chest pain, and family history.
   • Treatment with (NSAID) and observation of kidney function.
8. Porphyria
   • Abdominal pain: tachycardia, increased BP, and NEUROLOGIC_ symptoms such as paralysis, seizure, or coma.

Dubai Pediatric Clinic at Dr. Rami Hamed Center provides one of the leading pediatricians in Dubai. Please call +97142798200 to book an appointment today with us!