Abdominal Pain Management in Children Essay
Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues.Abdominal Pain Management in Children Essay
Common causes of pain in the abdomen include gastroenteritis and irritable bowel syndrome.[2] About 10% of people have a more serious underlying condition such as appendicitis, leaking or ruptured abdominal aortic aneurysm, diverticulitis, or ectopic pregnancy.[2] In a third of cases the exact cause is unclear.[2]
Given that a variety of diseases can cause some form of abdominal pain, a systematic approach to examination of a person and the formulation of a differential diagnosis remains important.Abdominal Pain Management in Children Essay
Acute abdominal pain is a common presentation in the outpatient setting and can represent conditions ranging from benign to life-threatening. If the patient history, physical examination, and laboratory testing do not identify an underlying cause of pain and if serious pathology remains a clinical concern, diagnostic imaging is indicated. The American College of Radiology has developed clinical guidelines, the Appropriateness Criteria, based on the location of abdominal pain to help physicians choose the most appropriate imaging study. Ultrasonography is the initial imaging test of choice for patients presenting with right upper quadrant pain. Computed tomography (CT) is recommended for evaluating right or left lower quadrant pain. Conventional radiography has limited diagnostic value in the assessment of most patients with abdominal pain. The widespread use of CT raises concerns about patient exposure to ionizing radiation. Strategies to reduce exposure are currently being studied, such as using ultrasonography as an initial study for suspected appendicitis before obtaining CT and using low-dose CT rather than standard-dose CT. Magnetic resonance imaging is another emerging technique for the evaluation of abdominal pain that avoids ionizing radiation.Abdominal Pain Management in Children Essay
Abdominal pain is a common presentation in the ambulatory setting, accounting for 1.5% of all office-based visits and 8% of all emergency department visits in the United States in 2010.1 Acute abdominal pain has many potential underlying causes, ranging from benign, self-limited conditions to life-threatening surgical emergencies. Although the patient history, physical examination, and laboratory test results can narrow the differential diagnosis, imaging is often required for definitive diagnosis and treatment.
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.Abdominal Pain Management in Children Essay
Abdominal pain is a common problem in children. Although most children with acute abdominal pain have self-limited conditions, the pain may herald a surgical or medical emergency. The most difficult challenge is making a timely diagnosis so that treatment can be initiated and morbidity prevented. This article provides a comprehensive clinical guideline for the evaluation of the child with acute abdominal pain.
Psychophysiology
Clinically, abdominal pain falls into three categories: visceral (splanchnic) pain, parietal (somatic) pain, and referred pain.
Visceral pain occurs when noxious stimuli affect a viscus, such as the stomach or intestines. Tension, stretching, and ischemia stimulate visceral pain fibers. Tissue congestion and inflammation tend to sensitize nerve endings and lower the threshold for stimuli. Because visceral pain fibers are bilateral and unmyelinated and enter the spinal cord at multiple levels, visceral pain usually is dull, poorly localized, and felt in the mid line. Pain from foregut structures (e.g., lower esophagus, stomach) generally is felt in the epigastrium. Midgut structures (e.g., small intestine) cause periumbilical pain, and hind gut structures (e.g., large intestine) cause lower abdominal pain.Abdominal Pain Management in Children Essay
Parietal pain arises from noxious stimulation of the parietal peritoneum. Pain resulting from ischemia, inflammation, or stretching of the parietal peritoneum is transmitted through myelinated afferent fibers to specific dorsal root ganglia on the same side and at the same dermatology level as the origin of the pain. Parietal pain usually is sharp, intense, discrete, and localized, and coughing or movement can aggravate it.
Referred pain has many of the characteristics of parietal pain but is felt in remote areas supplied by the same dermatome as the diseased organ. It results from shared central pathways for afferent neurons from different sites. A classic example is a patient with pneumonia who presents with abdominal pain because the T9 dermatome distribution is shared by the lung and the abdomen.1
Abdominal pain in children is a common problem. About 1 out of 3 children is seen by a doctor for abdominal pain by the time they are age 15, but only a small number of these children have a serious problem.Abdominal Pain Management in Children Essay
Complaints of abdominal pain are more common in children younger than 11 years and are often caused by changes in eating and bowel habits. Most cases of abdominal pain are not serious, and home treatment is often all that is needed to help relieve the discomfort.
Abdominal pain in children is often frightening and frustrating for parents. Many times it is hard to find the exact cause of a child’s abdominal pain. Pain without other symptoms that goes away completely in less than 3 hours is usually not serious.
In children, abdominal pain may be related to injury to the abdomen or an illness, such as an upset stomach, an ear infection, a urinary tract infection, or strep throat. Abdominal symptoms can also occur from an infection passed on by animals or while traveling to a foreign country. Constipation is a common cause of abdominal pain in children. Some more serious causes of abdominal pain in children include appendicitis, lead poisoning, or problems with the intestines, such as intussusception or malrotation. Girls who start having menstrual periods may have abdominal pain each month, and the pain may be more severe in some months than others.Abdominal Pain Management in Children Essay
Generalized pain occurs in half of the abdomen or more. Localized pain is located in one area of the abdomen. Babies and toddlers often react differently to pain than older children who can talk about their pain. A baby may become fussy, draw his or her legs up toward the belly, or eat poorly. Older children may be able to point to the area of the pain and describe how severe it is.
Abdominal pain is a common symptom in children, and can have a myriad of causes, ranging from problems that get better on their own to medical or surgical emergencies. Clues to the underlying cause of a child’s abdominal pain include the age of the child, the type of pain — sharp, dull or cramp y, and the duration of the pain. Additional clues include whether the pain has accompanying symptoms such as vomiting or fever, and the location of the pain. Left-sided abdominal pain is most often caused by problems in organs located on the left side, such as the spleen, the left ovary or testicle, and the left side of the large intestine.
Acute Left-Sided Pain That Can Occur Throughout Childhood
Several causes of left-sided abdominal pain cause sudden and often severe pain. For example, the spleen – an organ that makes and filters blood cells, and helps fight infection — is located in the upper left abdomen. Blunt trauma to this part of the abdomen, or even the mid back, can cause injury to the spleen resulting in pain (Ref 1, Etiology section). Moreover, trauma to the spleen can result in a tear of the surrounding capsule, causing severe blood loss from the spleen (Ref 4, p. 1526), a medical emergency. The spleen can also become infected or enlarged, by causes such as Epstein Barr virus infection or congestion from abnormal cells in sickle cell disease, causing left upper abdominal pain. Appendicitis is usually a cause of right-sided abdominal pain, but can actually cause left-sided pain in the rare case of a child born with the appendix located on the left-side of the abdomen (Ref 6, background section).
Acute Left-Sided Abdominal Pain in Older children
Twisting of the left ovary, which is called ovarian torsion, will usually cause intermittent sharp abdominal pain that also may radiate down the left leg (Ref 4, p 1668), usually in girls age 12 years and over (Ref 1, Table 2). Pain occurs because the nerves around the ovary are inflamed. Ovarian torsion is an emergency because of the possibility of loss of the ovary due to impaired blood supply. The same problem of twisting can occur in the left testicle—which most commonly occurs in boys age 12 and over. Since the testicle, unlike the ovary, is visible, a parent may notice the tell-tale signs of scrotal swelling, tenderness and discoloration (Ref 4, p. 1651-1652).Abdominal Pain Management in Children Essay
Chronic Left-Sided Abdominal Pain
Constipation, a common cause of left-sided abdominal pain, is characterized by stools that are infrequent or difficult to pass. The pain is often cramping, and relieved by a bowel movement. Other than abdominal pain, symptoms of constipation that a child may experience include pain during s tooling, blood on the stool or tissue paper after wiping, fecal soiling and wetting himself (Ref 2, p. 2). Risk for constipation is increased when a child’s diet is lacking adequate fiber sources, such as vegetables, fruit and whole grains (Ref 3). A left groin hernia can cause abdominal pain. A hernia occurs when abdominal organs, usually the intestine, enter the groin through an opening in the abdominal wall. Parents may notice a bulge in the child’s groin. Half of these cases occur in children under 1 year old. A groin hernia can cause acute pain and become an emergency if it gets trapped in the abdominal wall — called an incarcerated hernia — because it chokes off blood flow to the trapped organ.Abdominal Pain Management in Children Essay
Pain in this area of the body can be due to a variety of issues, some of which are more common than others, according to Shilpa Ravella, MD, assistant professor of medicine at Columbia University Medical Center in New York City.
“Some causes of lower left abdominal pain are benign, like gas or indigestion, while others are more serious,” says Dr. Ravella. “The left lower abdomen is home to the last part of the colon, so abnormalities in this area can be responsible for the pain.” However, she adds, left abdominal pain can also be caused by pain radiating from other areas of the body, such as the upper abdominal structures, kidneys, bladder or ovaries.Abdominal Pain Management in Children Essay
Signs You Should See a Doctor, Stat
So, when should you seek medical attention? According to David Cutler, MD, family medicine physician at Providence Saint John’s Health Center in Santa Monica, Calif., pain that falls into any of the following categories should be evaluated by a physician as soon as possible:
- persists for more than a day
- is severe or worsening
- is accompanied by fever
- has associated symptoms like vomiting or diarrhea
Common Causes
Below are the common causes of lower left abdominal pain. Read through to determine which condition might be ailing you.
1. Gas or Indigestion
Oftentimes the cause of sharp lower left abdominal pain that comes on suddenly, especially after eating a sizable meal, is nothing more than a little gas buildup. Treatment can involve the use of medications that alleviate gas, or dietary changes, says Dr. Ravella.
If, however, these symptoms do not fade within a few hours and/or are accompanied by additional concerning symptoms, like fever, constipation, diarrhea (with or without blood), nausea or vomiting, make an appointment with your doctor, as it may be something more serious. According to the Mayo Clinic, you should seek immediate medical attention if you’re also experiencing shortness of breath, sweating or chest pain radiating to the jaw, neck or arm.Abdominal Pain Management in Children Essay
2. Diverticulitis
One of the most common causes of left lower abdominal pain is diverticulitis. “Diverticula are small pouches that arise from weak spots in the colon that can become inflamed,” explains Dr. Ravella.
While abdominal pain is certainly one common symptom, it’s not the only one. Other symptoms of diverticulitis may include constipation, cramping, fever, chills, vomiting and nausea.
Keep in mind that your risk for this condition increases with age. In fact, about half of all people over the age of 60 have it, according to Medline Plus, a site run by the U.S. National Library of Medicine. Dr. Ravella recommends seeing a doctor if you have acute pain in the left lower side that does not go away, especially with any of the associated symptoms.
3. Inflammatory Bowel Disease
According to the Centers for Disease Control and Prevention, inflammatory bowel disease (IBD) is a broader term for two conditions that cause chronic inflammation of the gastrointestinal tract: Crohn’s disease and ulcerative colitis.
While the presentation of IBD can vary, it can sometimes cause sharp pain in the lower left abdomen. If you’re experiencing this pain consistently along with diarrhea, with or without blood, IBD very well may be the culprit.
If the pain does not subside, and especially if you have frequent diarrhea and/or a family history of IBD, Dr. Ravella recommends seeing your physician for evaluation. If you do indeed have IBD, your doctor may prescribe an immunosuppressive medication.
4. Colo rectal Cancer
This serious condition is much more common in older patients over the age of 50, and symptoms can include abdominal pain coupled with a change in bowel habits or iron deficiency anemia.Abdominal Pain Management in Children Essay
“Cancer can block the bowel, causing sharp lower left abdominal pain and bleeding, as well as a potential rupture,” says Anton Bilchik, MD, PhD, professor of surgery and chief of gastrointestinal research at the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif.
Colon cancer is the second-most common cause of cancer related deaths in the U.S., with a six-fold increase in millennial’s being diagnosed, according to a February 2017 study in the Journal of the National Cancer Institute. So it’s certainly worth it to schedule an evaluation with your doctor, no matter your age.
5. Hernia
If your left-hand-side abdominal pain is accompanied by a lump or bulge in your abdomen and/or groin, the cause may be a hernia. This common and treatable condition is marked by a weakness or hole in the peritoneum, the wall of muscle that holds your abdominal organs in place, according to the Cleveland Clinic.
“The pain may feel sharp or like a dull ache, and you may experience even more discomfort while lifting heavy objects,” says Dr. Ravella. “Treatment may involve surgery, depending on the severity of the case.”
6. Kidney Stones
Considered one of the most painful conditions, symptoms of kidney stones tend to come on abruptly and can be experienced in the lower left abdomen as well as the sides and back. You may also see changes in the color of your urine as well as experience nausea, vomiting, fever and chills, notes Dr. Ravella.
Although it’s not the most common condition, affecting approximately 11 percent of men and 6 percent of women in their lifetime, according to the National Institute of Diabetes and Digestive and Kidney Diseases, you should see your doctor right away if you suspect you have a kidney stone.
“Treatment usually involves pain control and hydration, but intervention by a urologist may be indicated for severe cases,” says Dr. Ravella.
For the purpose of the case study I intend to use Gibbs(1998) model of reflection as this model is clear, precise allowing for description, analysis and evaluation of the experience, then prompts the practitioner to formulate an action plan to improve their practice in future(Jasper, 2003).Abdominal Pain Management in Children Essay