Acute abdominal pain in a child

The abdominal organs are innervated in two ways. Accordingly, visceral pain is formed in the tissues themselves and spreads from the visceral pleura along the branches of the autonomic nervous system. The feeling of somatic pain comes from the wall of the abdominal cavity and the parietal peritoneum, supplied by branches of the central nervous system.

The main causes of visceral pain are: rapid increase in pressure in hollow organs, tension of the capsule, intense muscle contraction. By nature, visceral pains are squeezing, stabbing or piercing and can be accompanied by nausea, vomiting, pallor, sweating, and anxiety of the patient. They intensify at rest and are relieved by turning in bed and walking. Small children "kick their legs" with such pain. Visceral pains are most often manifested by intestinal colic.

Somatic pain occurs when the peritoneum or mesentery is irritated. It is characterized by constancy, localized in the place of the greatest lesion (for example, the right lower abdomen in appendicitis), the irradiation of pain corresponds to the neurosegment of the affected organ. Somatic pain comes from the parietal peritoneum, the wall of the abdominal cavity, from the retroperitoneal space. For practical purposes, it is justified to divide pain into acute ("acute abdomen") and chronic or chronically recurring.

A patient with abdominal pain requires contact between a therapist (pediatrician) and a surgeon - constant or episodic (but no less important). When analyzing pain, the doctor should clarify the following questions:

1. the onset of pain;
2. conditions for its appearance or intensification;
3. development;
4. migration;
5. localization and radiation:
6. nature of pain;
7. intensity;
8. Duration:
9. conditions for pain relief.

Acute pain is interpreted based on the criteria of its onset, intensity, location of occurrence and general condition of the patient. An accurate answer to these questions is important for differential diagnostics of surgical and therapeutic acute abdominal pain. Such a choice is always difficult and responsible. Even after a seemingly final answer to the question in favor of therapeutic pain, i.e. non-surgical, therapeutic treatment, the doctor must constantly return to the problem of differential diagnostics of surgical and therapeutic pain. After all, acute pain can be the onset of a new disease (for example, appendicitis) or an unexpected manifestation of a chronic disease (penetration of a stomach ulcer).

The phrase "acute abdomen" implies intense abdominal pain that occurs suddenly and continues for several hours. Such pains often have an unspecified etiology and, based on the local and general clinical picture, are perceived as an urgent surgical situation. The main symptom of surgical "acute abdomen" is intense, colicky or prolonged pain, usually accompanied by ileus and/or symptoms of peritoneal irritation, which distinguishes them from therapeutic pathology.

With colic-like visceral pain (pain due to cholelithiasis, mechanical ileus), patients double over in pain and toss and turn in bed.

In case of somatic pain (peritonitis), patients are motionless and lie on their backs. Muscle guarding, Shchetkin-Blumberg symptom, and pain on percussion at the site of greatest irritation of the peritoneum are determined. For further differential diagnostics, it is necessary to percussion the liver area (there is no dullness in pneumoperitoneum), auscultate intestinal sounds ("dead silence" in peritonitis, high-pitched metallic sounds in mechanical ileus), and perform rectal and gynecological examinations. Local signs are accompanied by general symptoms: fever, leukocytosis with neutrophilia and toxic granularity, vomiting, gas and stool retention, tachycardia, thready pulse, dry tongue, excruciating thirst, exsicosis, sunken eyes and cheeks, pointed nose, spotty hyperemia of the face, anxiety, cold sweat, and a drop in blood pressure. These general changes indicate both surgical pathology and the prevalence and severity of the process.

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