Το παιδί είναι πιο πιθανό να έχει ιδιοπαθή υποτροπιάζοντα πόνο στην κοιλιά όταν:
- Εστιάζει τον πόνο γενικά στο κέντρο της κοιλιάς και στον ομφαλό
- Δεν έχει δυνατό πόνο, ο πόνος δεν περιορίζει την δραστηριότητά του και συνήθως απλώς αναφέρεται χωρίς να απαιτεί παυσίπονο
- Ο πόνος στην κοιλιά δεν το ξυπνάει τη νύχτα
- Ο πόνος στην κοιλιά δεν σχετίζεται με τα γεύματα
- Τα επεισόδια πόνου δεν είναι συχνά και δεν φαίνονται να χειροτερεύουν με την πάροδο του χρόνου
- Ο πόνος δεν συνοδεύεται από άλλα συμπτώματα όπως εμετούς και διάρροιες, στασιμότητα ή απώλεια βάρους
- Ο πόνος έχει συσχέτιση με στρεσογόνες καταστάσεις, όπως κατά τις μέρες του σχολείου ή να περνάει σε σαββατοκύριακα ή διακοπές, γέννηση αδερφού, διαζύγιο, παιδική παραμέληση ή κακοποίηση
- Ο πόνος στην κοιλιά ή πονοκέφαλος αναφέρεται συχνά σαν σύμπτωμα μέσα στην οικογένεια από άλλα μέλη της
- Ο πόνος είναι σοβαρής έντασης και περιορίζει την δραστηριότητα του παιδιού
- Ο πόνος ξυπνάει το παιδί τη νύχτα (έλκος)
- Ο πόνος έχει εντόπιση στο πάνω μέρος της κοιλιάς ή/ και συνοδεύεται με τάση για εμετό ή εμετό (έλκος, γαστρίτιδα, γαστρο-οισοφαγική παλινδρόμηση)
- Ο πόνος έχει εντόπιση προς δεξιά κάτω και μπορεί να συνοδεύεται από τάση προς εμετό ή εμετό (υποξεία σκωληκοειδίτιδα)
- Ο πόνος έχει εντόπιση προς αριστερά κάτω και συνοδεύεται από δυσκοιλιότητα
- Ο πόνος έχει εντόπιση χαμηλά στο υπογάστριο ή/ και συνοδεύεται από τσούξιμο ή άλλα συμπτώματα κατά την ούρηση (ουρολοίμωξη, νεφρολιθίαση)
- Ο πόνος συσχετίζεται με κατανάλωση γάλακτος (δυσανεξία στην λακτόζη) ή με κατανάλωση γλουτένης (κοιλιοκάκη)
- Ο πόνος συνοδεύεται από συμπτώματα όπως εμετούς, διάρροιες, ανορεξία, στασιμότητα βάρους, αίμα στα κόπρανα (φλεγμονώδης νόσος του εντέρου)
- Ο πόνος είναι παροξυσμικός με επεισόδια εμέτων ή με πονοκεφάλους (κοιλιακή ημικρανία)
- Ο πόνος χειροτερεύει σε άδειο στομάχι (έλκος)
- Ο πόνος συνοδεύεται από πυρετό ή δυσκολία στην ανάσα (πνευμονία, άσθμα)
- Στρες
- Δυσκοιλιότητα
- Σύνδρομο ευερέθιστου εντέρου
- Κοιλιακή ημικρανία
- Κάκωση στους κοιλιακούς μυς
- Κοιλιοκάκη
- Τροφικές αλλεργίες
- Δυσανεξία στην λακτόζη
- Φλεγμονώδη νόσο του εντέρου
- Υποξεία σκωληκοειδίτιδα
- Ουρολοίμωξη
- Νεφρολιθίαση
- Έλκος
- Γαστρο-οισοφαγική παλινδρόμηση
- Παγκρεατίτιδα
- Χολολιθίαση
- Εντερική απόφραξη
- Όγκος στην κοιλιά
SOURCE:Παιδιατρική Φροντίδα
Abdominal Pain: Common Causes of Stomach Pain in Children
Just A 'Tummy Ache,' or More?
Abdominal pain is one of the most common
reasons for a parent to bring his or her child to a health care
professional. Evaluation of a "tummy ache" can challenge both parents
and the doctor.
Causes of Abdominal Pain in Children
Possible causes for a child's abdominal pain
range from trivial to life-threatening with little difference in the
child's complaints and symptoms. Fortunately, abdominal pain in a child
usually improves quickly. Parents or caregivers face the difficult
decision of whether a complaint needs emergency care or not. We’ll look
at some of the most common causes of abdominal pain in children the
following slides.
Causes - Infections
Viruses or bacteria can cause abdominal
pain, typically from stomach flu or gut flu (called gastroenteritis).
Often these infections are associated with other gastrointestinal
symptoms such as cramps, nausea, and diarrhea. Viral infections tend to
resolve quickly, while bacterial infections may need an antibiotic to
improve.
Causes - Food-Related
Food poisoning (which has symptoms like
those of stomach/gut flu), food allergies, eating excessive amounts of
food – any of these can cause temporary discomfort.
Causes - Poisoning
Poisoning: This can range from simple
problems, such as eating soap, to more serious issues like swallowing
iron pills or an overdose of medications (such as acetaminophen
poisoning [Tylenol]).
Causes - Surgical Problems & Medical Causes
Surgical problems for abdominal pain include appendicitis and blockage of the bowels.
In addition, things outside the abdomen can cause abdominal pain. For example, a child can have abdominal pain from complications of diabetes or from a black widow spider bite.
In addition, things outside the abdomen can cause abdominal pain. For example, a child can have abdominal pain from complications of diabetes or from a black widow spider bite.
Symptoms of Abdominal Pain in Children
A parent or caregiver usually can tell when a
child has abdominal pain. Infants and very young toddlers may cry, have
painful facial expressions, and curl up. Young children usually will be
quick to tell you what is wrong. Some teenagers may be reluctant to
report pain, and you must try to get a clear explanation of what they
are feeling. Symptoms to ask about are discussed on the following
slides.
Symptoms - Duration of the Pain
An important thing to remember is that most
simple causes of abdominal pain do not last very long. Most of us have
experienced gas pains or the stomach/gut flu and remember that the pain
usually was gone within 24 hours. Any abdominal pain that continues
longer than 24 hours should be evaluated by a physician.
Symptoms - Location of the Pain
Most simple pains are located in the center
of the abdomen. The child will rub around his or her belly button. Pain
felt in other areas is more concerning. This is especially true of pain
located low and down on the right side of the abdomen. Pain in that area
is considered to be appendicitis until proven otherwise.
Symptoms - Appearance of the Child
As a general rule, if the child looks very
ill in addition to being in pain, medical help should be sought. Often,
the caregiver "just knows" the child is sick. Key things to look for
when abdominal pain occurs include pale appearance, sweating, or a child
who is sleepy or listless. It is most concerning when a child cannot be
distracted from the pain with play, or refuses to drink or eat for
several hours.
Symptoms - Vomiting
Children vomit quite frequently with
abdominal pain, but vomiting does not always indicate a serious problem.
However, as with the duration of the pain, most simple causes of
vomiting go away very quickly. The rule again is that vomiting for
longer than 24 hours is a legitimate reason to call the physician.
Symptoms - Nature of the Vomiting
At any age, vomiting that appears to contain
blood or darker material is a reason to seek emergency care. Prolonged
vomiting and the inability to keep down liquids can lead to dehydration.
Signs of dehydration such as a dry mouth and no urine is another
reason to seek emergency care.
Symptoms - Diarrhea
This is also very common with abdominal pain
and often indicates that a virus is the cause. This can continue for
several days but usually lasts less than 72 hours (three days).
Diarrhea, especially when associated with vomiting, can lead to
dehydration. Any blood in the stool is a reason to seek medical care.
Symptoms - Fever
The presence of fever does not always
indicate a serious problem. Moreover, a normal temperature can be seen
with the more serious causes of abdominal pain.
Symptoms - Groin Pain
One serious problem that a boy may describe
as abdominal pain actually comes from somewhere else. It is testicular
torsion, a condition in which a testicle twists on itself and cuts off
its own blood supply. The child may be embarrassed to mention the
location, so you should ask if there is any pain "down there." A
testicular problem is usually easy to fix if treated early. So, if a
child complains of pain in the groin area or testicles, seek emergency
medical care.
Symptoms - Urinary Problems
Abdominal pain associated with any trouble
urinating, such as painful or frequent urination, could indicate a
bladder infection and is a reason to seek medical care.
Symptoms - Rash
Certain serious causes of abdominal pain
also occur with a new rash. The combination of a skin rash with
abdominal pain is a reason to contact your doctor.
Exams and Tests
Abdominal pain in children has several
potential causes that may affect multiple organ systems, each requiring a
unique set of diagnostic tests. The doctor will obtain a thorough
history and examine the child, which likely will include a rectal exam
to evaluate the presence of blood in the stool. From this information
the doctor may order additional tests.
Blood tests, stool samples, imaging studies (including X-rays, ultrasound, and CT scans), as well as other special tests (barium enema/swallow, or pelvic exam) may be done. In some cases a specialist such as a gastroenterologist or pediatric surgeon may be consulted.
Blood tests, stool samples, imaging studies (including X-rays, ultrasound, and CT scans), as well as other special tests (barium enema/swallow, or pelvic exam) may be done. In some cases a specialist such as a gastroenterologist or pediatric surgeon may be consulted.
Self-Care at Home
A parent or caregiver must be observant and
should contact appropriate help at the appropriate time. A child should
especially be monitored closely when he or she is recovering. A teenager
may not want to be bothered, but still should be monitored. The
following slides offer tips for self-care at home.
Self-Care at Home - Rest
A child with active abdominal pain often
will benefit from resting. Lying face down may help relieve gas pain,
but the optimal position is the one that feels best to the child.
Self-Care at Home - Diet
People can survive a long time without solid
food, but need to keep up on liquids. Dehydration takes time to develop
unless vomiting or diarrhea is severe, so forcing fluids is not always
necessary. A child who is actively vomiting will not be able to hold
down a large amount of liquid. Doctors recommend giving small amounts
(1-2 ounces) at a time (every 15-20 minutes typically) until the child
can handle more.
Self-Care at Home - Fluids to Give
Do not give water or boiled milk to infants
in large quantities, because it can cause serious problems with the salt
content of their bodies. Doctors recommend various liquids for
preventing and treating dehydration. For example, Pedialyte can be
bought over-the-counter without a prescription. Try to get the infant
back on the usual feedings as soon as possible. Good choices for older
children include ginger ale or simple soup broth. Avoid any liquids that
aggravate the abdominal pain. If an older child asks for soft drinks,
it may be better to avoid those with caffeine. Shaking the fizz out of
carbonated beverages may make them more tolerable for an ill child.
Self-Care at Home - Solid Foods
The child will let you know when it is time
to get back on solid food. Start them slowly. First try toast or
crackers. Then advance to regular foods as they tolerate the feedings.
Banana, apple sauce, or cooked rice also are suitable foods for
introduction after a full liquid diet.
Self-Care at Home - Medications
You can use acetaminophen (Aspirin Free,
Children's Silapap, Panadol, Liquiprin, or Tylenol) to control fever.
Most doctors still avoid aspirin in children. Avoid antibiotics unless
prescribed by a doctor. Physicians do not recommend herbal medicines or
other home remedies. If you use them and later see a physician, be sure
to tell the physician exactly what you gave the child because it could
affect the treatment recommendations.
Medical Treatment
Treatment will be prescribed according to
the history, physical examination, and test results. Treatment may be as
simple as sending the child home with instructions for rest,
encouraging fluids, and eating a bland diet. For serious conditions,
treatment can be as extensive as hospital admission and surgery.
When to Call a Doctor
Call your child’s doctor immediately if your child is experiencing any of the symptoms listed
Outlook
The prognosis for abdominal pain in children
is as diverse as the causes themselves. Abdominal pain identified and
treated early carries a good prognosis overall; however, pain
undiagnosed and untreated can be life-threatening. Consequently, early
in the child's illness, a parent or caregiver should work with the
pediatrician and hospital to ensure the child receives appropriate careSOURCE:MedicineNet
REFERENCES:
- eMedicineHealth: Abdominal Pain in Children
© 2005 - 2013 WebMD, LLC. eMedicineHealth. All rights reserved. Source article on eMedicineHealth - WebMD: Abdominal Pain in Children Treatment
© 2005 - 2013 WebMD, LLC. All rights reserved. Source article on WebMD
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