Acute abdominal pain in the child
The organs of the abdominal cavity are innervated in two ways. Accordingly, visceral pain is formed in the tissues proper 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 with branches of the central nervous system.
The main causes of visceral pain: rapid increase in pressure in the hollow organs, tension of the capsule, intensive muscle contraction. By the nature visceral pains compressing, pricking or piercing can be accompanied by nausea, vomiting, pallor, sweating, anxiety of the patient. Strengthen in peace and ease with turns in bed, walking. Little children with such pain "pinch their legs." More often visceral pains manifest with intestinal colic.
Somatic pains occur with irritation of the peritoneum or mesentery. Are characterized by constancy, localized in the place of the greatest lesion (for example, the right lower abdomen with appendicitis), the pain irradiation corresponds to the neural segment of the affected organ. Somatic pains come from the parietal peritoneum, the abdominal wall, from the retroperitoneal space. For practical purposes, the division of pain into acute ("acute abdomen") and chronic or chronically recurrent is justified.
A patient with abdominal pain requires the contact of the therapist (pediatrician) and the surgeon - a constant or episodic (but no less important). When analyzing pain, the doctor should clarify the following questions for himself:
- the onset of pain;
- the conditions for its appearance or amplification;
- localization and radiation:
- nature of pain;
- conditions of relief of pain.
Acute pains are interpreted according to the criteria of their onset, intensity. At the place of origin and the general condition of the patient. The exact answer to these questions is important for the differential diagnosis of surgical and therapeutic acute abdominal pain. This choice is always complex and responsible. Even after a seemingly definitive answer to the question posed in favor of therapeutic pain, i.e. Nonoperative, therapeutic treatment, the doctor must constantly return to the problem of differential diagnosis of surgical and therapeutic pain. After acute pain can be the beginning of a new disease (for example, appendicitis) or an unexpected manifestation of chronic (penetration of the stomach ulcer).
The phrase "acute abdomen" implies intense abdominal pain that occurs abruptly and lasts for several hours. Such pains often have an undefined aetiology and are perceived by the local and general clinical picture as an urgent surgical situation. The main symptom in a surgical "acute abdomen" is intense, colicky or prolonged pain, usually accompanied by ileus and / or symptoms of irritation of the peritoneum, which distinguishes them from the therapeutic pathology.
With colicky visceral pain (pain in cholelithiasis, mechanical ileus), patients crook in pain, rush into bed.
With somatic pain (peritonitis), patients are immobile, lying on their backs. Defined muscular defenses, a symptom of Shchetkin-Blumberg, pain with percussion in the place of the greatest irritation of the peritoneum. In order to further differential diagnosis, it is necessary to percussion the liver region (stupidity absent with pneumoperitoneum), auscultation of intestinal noises ("death silence" - with peritonitis, high metal sounds with mechanical ileus), rectal and gynecological examinations. Local signs are accompanied by general symptoms: fever, leukocytosis with neutrophilia and toxic granularity, vomiting, gas and stool retention, tachycardia, threadlike pulse, dry tongue, painful thirst, exsicosis, sunken eyes and cheeks, pointed nose, spotty hyperemia of the face, cold sweat, falling blood pressure. These common changes indicate both surgical pathology and the prevalence and severity of the process.