Acute abdominal pain in children

Acute abdominal pain in children presents a diagnostic dilemma. Although many cases of acute abdominal pain are benign, some require rapid diagnosis and treatment to minimize morbidity. Numerous disorders can cause abdominal pain. The most common medical cause is gastroenteritis, and the most common surgical cause is appendicitis. In most instances, abdominal pain can be diagnosed through the history and physical examination. Age is a key factor in evaluating the cause; the incidence and symptoms of different conditions vary greatly over the pediatric age spectrum. In the acute surgical abdomen, pain generally precedes vomiting, while the reverse is true in medical conditions. Diarrhea often is associated with gastroenteritis or food poisoning. Appendicitis should be suspected in any child with pain in the right lower quadrant. Signs that suggest an acute surgical abdomen include involuntary guarding or rigidity, marked abdominal distention, marked abdominal tenderness, and rebound abdominal tenderness. If the diagnosis is not clear after the initial evaluation, repeated physical examination by the same physician often is useful. Selected imaging studies also might be helpful. Surgical consultation is necessary if a surgical cause is suspected or the cause is not obvious after a thorough evaluation.     

Acute abdominal pain in the presence of hemi-corporeal neurosensory deficits

Acute abdominal conditions may be extremely difficult to diagnose in patients with spinal cord neurologic deficits. Sydngomyelia, and the surgical treatment of it, can cause an unusual distribution of nearosensory defects involving primarily pain and temperature sensation, and this can mask occult intraabdominal pathology. We report a case of acute abdominal pain In a patient previously treated with a syringo-pleural shunt for correction of a cervical syringomyeila and the difficulties in diagnosis that this presents.     

Assessing recurrent abdominal pain in children

Recurrent abdominal pain is a frequent complaint of school-aged children. In 5-10 percent of the cases, RAP is the result of organic disease. Specific history and physical assessments are needed to detect organic disease. The assessment tool described in this article is a functional adjunct to a nurse practitioner's evaluation of RAP as well as of other recurrent pain. It provides additional information to identify less obvious organic causes and serves as a basis for involving the patient in development of a treatment plan.     

儿童腹痛

患者,女,13岁,自述有上腹部疼痛伴呕吐6个月。患者6个月前无明显诱因下出现上腹部疼痛,为绞痛,呈阵发性。腹痛常在呕吐后慢慢缓解,同时,有恶心、呕吐,呕吐物为胃内容物,常常伴1～2次腹泻样大便。腹痛发作2～3d后,病人可正常饮食。这样的症状常常发生在晚上,一般4周左右发作一次,但与月经周期无关。二次发病间隔期,女孩胃口正常,无其他症状,无咯血,无血脓便,无发热。除急性发作期,大便正常,生长和体重正常。每次症状出现时,病人被送至急诊室,经解痉治疗后,症状缓解出院。     

Normalizing: postoperative acute abdominal surgical pain in Thai children

The purpose of this study was to gain a greater understanding of the postoperative pain experience of Thai children aged 5 to 7 years who had undergone abdominal surgery. A grounded theory approach was used to gain an understanding of the core process. A total of 15 children who had undergone abdominal surgery comprised the study. Data were collected by interviews, observations, and drawing and play interviews. The major task/hypothesis generated in this study was that children were addressing the process of normalizing and that creating an environment that allowed a child to normalize might be expected to greatly contribute to pain reduction.     

Assessment of abdominal pain in school-age children.

Pediatric abdominal pain can be a difficult condition to accurately assess for the nurse to determine whether the child's need is for teaching, treating, or transferring. This article describes the process as well as practical tips to be used by the nurse in the school setting. Distinguishing characteristics and findings, including key physical assessments, of some of the most frequent or most important conditions are described. Atypical, but not to be overlooked, causes are also discussed.     

Exteroceptive suppression of temporalis muscle activity: perspectives in headache and pain research

The paper describes possible future applications of the exteroceptive suppression (ES) of temporalis muscle activity in headache and pain research. ES is examined as a method for investigating the pathophysiology of pain mechanisms, for assisting clinical diagnosis, and for evaluating therapeutic effects. ES is one of the newest methods in headache research which permits an objective analysis of head pain as well as pain mechanisms and accordingly has an important future in headache research.     

Potential biobehavioral mechanisms of recurrent abdominal pain in children

To explain why otherwise healthy children experience recurrent episodes of abdominal pain (the recurrent abdominal pain syndrome, or RAP), it has been hypothesized that the child with RAP demonstrates: (1) a deficit in autonomic nervous system recovery to stress, and/or (2) an enhanced behavioral and subjective response to pain. To evaluate the validity of these assumptions, children with RAP (9–14 years) and hospital and healthy controls matched for age, sex, ethnicity and SES were exposed to a cold pressor stimulus (0 ± 1°C). Autonomic (peripheral vasomotor and heart rate), somatic (forearm EMG), subjective (pain intensity and distress), and behavioral (facial expression) responses were recorded during baseline, stressor and recovery periods. At all 4 levels of observation, the cold pressor stimulus resulted in significant autonomic, somatic, subjective and behavioral arousal. However, no significant differential response across the 3 groups was noted for any measure and, in particular, no recovery deficit in autonomic arousal was demonstrated. These findings do not support the assumption of a differential response to an acute laboratory induced stress in children with RAP compared to control children.     

再发性腹痛儿童幽门螺杆菌IgG测定及分析

目的　探讨儿童再发性腹痛 (RAP)与幽门螺杆菌 (HP)感染的关系。方法　采用酶联免疫吸附法检测血清中相应的HP -IgG抗体。 结果　 2 662例再发性腹痛儿童 ,HP -IgG阳性者 789例 ,检出率 2 9 64 %;男女性别感染率无显著性差异 ,P >0 0 5。结论　①再发性腹痛儿童HP感染状况不容忽视 ;②血清学方法可作为HP感染初步筛选试验 ,根据其结果再进行1 3 C尿素呼气试验 ( 1 3 C -UBT)判断HP感染状态。两种试验方法结合诊断HP感染具有创伤小、准确、快速、相对经济的优点     

Abdominal migraine: an under-diagnosed cause of recurrent abdominal pain in children

(Headache 2011;51:707‐712) Objective.— Our objective was to demonstrate that, despite recognition by both the gastroenterology and headache communities, abdominal migraine (AM) is an under‐diagnosed cause of chronic, recurrent, abdominal pain in childhood in the USA. Background.— Chronic, recurrent abdominal pain occurs in 9‐15% of all children and adolescents. After exclusion of anatomic, infectious, inflammatory, or other metabolic causes, “functional abdominal pain” is the most common diagnosis of chronic, idiopathic, abdominal pain in childhood. Functional abdominal pain is typically categorized into one, or a combination of, the following 4 groups: functional dyspepsia, irritable bowel syndrome, AM, or functional abdominal pain syndrome. International Classification of Headache Disorders—(ICHD‐2) defines AM as an idiopathic disorder characterized by attacks of midline, moderate to severe abdominal pain lasting 1‐72 hours with vasomotor symptoms, nausea and vomiting, and included AM among the “periodic syndromes of childhood that are precursors for migraine.” Rome III Gastroenterology criteria (2006) separately established diagnostic criteria and confirmed AM as a well‐defined cause of recurrent abdominal pain. Methods.— Following institutional review board approval, a retrospective chart review was conducted on patients referred to an academic pediatric gastroenterology practice with the clinical complaint of recurrent abdominal pain. ICHD‐2 criteria were applied to identify the subset of children fulfilling criteria for AM. Demographics, diagnostic evaluation, treatment regimen and outcomes were collected. Results.— From an initial cohort of 600 children (ages 1‐21 years; 59% females) with recurrent abdominal pain, 142 (24%) were excluded on the basis of their ultimate diagnosis. Of the 458 patients meeting inclusion criteria, 1824 total patient office visits were reviewed. Three hundred eighty‐eight (84.6%) did not meet criteria for AM, 20 (4.4%) met ICHD‐2 formal criteria for AM and another 50 (11%) had documentation lacking at least 1 criterion, but were otherwise consistent with AM (probable AM). During the observation period, no children seen in this gastroenterology practice had received a diagnosis of AM. Conclusion.— Among children with chronic, idiopathic, recurrent abdominal pain, AM represents about 4‐15%. Given the spectrum of treatment modalities now available for pediatric migraine, increased awareness of cardinal features of AM by pediatricians and pediatric gastroenterologists may result in improved diagnostic accuracy and early institution of both acute and preventative migraine‐specific treatments.     

Effects of stress on pain threshold and tolerance in children with recurrent abdominal pain

Models of stress-induced hyperalgesia state that exposure to stress can exaggerate subsequent pain experiences. Studies using both animal and human subjects have shown evidence for hyperalgesia as a function of stress [e.g., Jorum E. Analgesia or hyperalgesia following stress correlates with emotional behavior in rats. Pain 1988;32:341-48; Peckerman A, Hurwitz BE, Saab PG, Llabre MM, McCabe PM, Schneiderman N. Stimulus dimensions of the cold pressor test and the associated patterns of cardiovascular response. Psychophysiology 1994;31:282-90; Gameiro et al. Nociception and anxiety-like behavior in rats submitted to different periods of restraint stress. Physiol. Behav. 2006;87:643-49; Lucas et al. Visceral pain and public speaking stress: neuroendocrine and immune cell responses in healthy subjects. Brain Behav. Immun. 2006;20:49-56]. However, the role of stress in pediatric pain is not well understood. This study examined stress reactivity and pain tolerance and sensitivity in a population of children with Recurrent abdominal pain (RAP). Forty-nine children meeting criteria for RAP (28 female; mean age 13years; range 9-17years) were randomly assigned to either a condition in which they completed an experimental stressor paradigm (stress interview, serial subtraction task) followed by a pain task (cold pressor) or a condition in which they received the pain task prior to the stress tasks. Children who underwent the stress tasks before the pain task exhibited lower levels of pain tolerance than those who received the pain task first (p<.01); no differences were found between the two groups in pain threshold or pain intensity ratings. Further, pain tolerance was not related to individual differences in physiological reactivity (heart rate change) to the stressor. The present research demonstrates the first evidence of the occurrence of stress-induced hyperalgesia in a pediatric pain population.     

Recurrent abdominal pain in children and the endogenous opiates: a brief hypothesis

The aetiology of recurrent abdominal pain in children (RAP) remains unclear. Some features of this syndrome suggest that an opiate-like mechanism may be involved. The evidence for this is reviewed, and it is hypothesised that RAP may result from a differential gastrointestinal response to stress mediated by the endogenous opiate system.     

Functional abdominal pain and irritable bowel syndrome in children and adolescents

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are both associated with recurrent abdominal pain and are among the most commonly diagnosed medical problems in pediatrics. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Based on the biopsychosocial model of functional disease, the Rome III criteria have helped frame FAP and IBS in terms of being a positive diagnosis and not a diagnosis of exclusion. However, the lack of a single, proven intervention highlights the complex interplay of pathologic mechanisms likely involved in the development of childhood FAP and IBS and the need for a multidisciplinary, integrated approach. This article discusses the epidemiology, proposed mechanisms, clinical approach and therapeutic options for the management of FAP and IBS in children and adolescents.