Abdominal pain :

Common symptom
Lesion: - intra abdomen
- extra abdomen
For early diagnosis: - careful anamnesis
- physical examination
- further investigation
Surgical case or not?
Source of abdominal pain :
Viscera abdomen
Others organ outside of abdomen
Lesion of Medulla Spinalis
Metabolic disturbance
Psychosomatic
Pathogenesis
1. Vascular disorders
(emboli / thrombosis, rupture, occlusion caused
by torsion or tension)
2. Inflammation
Pain if the inflammation process are in
peritoneum parietalis somatic inervation
Local pain or general pain.
Type of pain : stabile, increase with movement of
inflammatory peritoneum
3. Passage disorders/obstruction of luminal
organ in peritoneal or retroperitoneal cavity
Partial obstruction or total obstruction intra
lumen pressure pain
4. Traction, inflammation and stretching of
peritoneum visceralis
Infant commonly caused by obstruction
a. Colic
b. Constipation
c. Volvulus
d. Intussusceptions/invagination
e. Strangulated hernia
f. Pyloric stenosis
g. Perforation of gastrointestinal tract
h. Appendicitis
i. Acute hydrops of gallbladder

Cause of abdominal pain by age groups


a. Gastroenteritis
b. Appendicitis
c. Mesenteric lymphadenitis
d. Meckels diverticulum
e. Ileitis regional
f. Colitis ulserativa
g. Diabetic acidosis
h. Pneumonia
i. Torsion of ovarian cord
j. Constipation
Older child commonly caused by infection

k. Pyelonephritis
l. Colic Ureter
m. Lead intoxication
n. Torsion of spermatic cord
o. Abdominal epilepsy
p. Sickle cell crisis
q. Mononucleosis
r. Porphiria
s. Cholecystitis and
cholelytiasis
t. Pancreatitis
Cause of acute abdominal pain by age groups,
that requirring surgical intervention
Infant / age < 2 years old
Abdomen :
Perforation of gastric ulcers
Bowel obstruction : - intusussception
- volvulus and malrotation
Appendicitis and enterocolitis necroticans
Extra abdomen :
Inguinal hernia with strangulation and incarceration
Age > 2 years old
Abdomen:
a. Obstruction
Bowel obstruction caused by fibrosis, volvulus, etc
b. Inflammation (appendicitis, primary peritonitis, etc)
c. Trauma (rupture of spleen, urinary bladder, another visceral
organs, hematoma sub serosa)
d. Bleeding (bleeding intra ovarian cyst)
e. In tropic area (perforation associated with ascariasis,
strongiloidiasis, etc)
Extra abdomen:
a. Torsion of testis
b. Inguinal hernia with strangulation and incarceration
Infant / age < 2 years old
Abdomen :
- Intestinal infection

Extra abdomen :
- Pneumonia
- Urinary tract infection
Cause of non surgical abdominal pain
(Walker and Smith, 1983)
b. Liver and billiary tree
- Hepatitis
- Cholelytiasis

c. Pancreas
- Pancreatitis

d. Kidney
- Urinary tract infection
- Stone
- Nephritis



e. Metabolic
- Phorphiria
- Hiperlipidemia
- Diabetic keto acidosis
- Familial Mediterranean
fever

f. Gynecologic
- Salphyngitis





Cause of abdominal pain in Indonesia
Neonatal - 3 months

- Cows milk allergy
- Pyloric hypertrophy
- Torsion of testis
- Obstipation/with
anal fissure
- Bowel malrotation




3 months 2 years

- Obstipation
- Gastroenteritis
- Bowel duplication
- Maldigestion
- Gastric mucosal
membrane
- Meckels diverticulum

> 5 years

- Appendicitis
- Gastritis
- Ovarian torsion
- Menstrual cycle
- Cholecystitis
- Functional
abdominal pain
- Urinary tract stone
- Varicocele testis

2 years 5 years

- Obstipation
- Volvulus
- Hepatitis
- Urinary tract
infection
- Ascariasis
- Appendicitis
- Pancreatitis

0 - 3 months : vomiting
3 months 2 years : vomiting, pitching/crying,
trauma(-)
2 5 years : can tell the pain, localization not
true
> 5 years : can tell the type and localization of
the pain

Clinical manifestation by age group

Diagnostic approach

1. Anamnesis
2. Physical examination
3. Laboratories and further investigation

Laboratory and further investigation

Routine ( urine, blood, feces)
Culture
3 positions of abdominal plan photo
Thorax photo (severe disease)
Barium meal/follow through
Barium enema
Intravenous pyelography
Ultrasound
Endoscopies
Therapy

Require surgical intervention?
Depend on etiology
Surgical abdominal pain

Abdominal pain that require surgical
intervention

Symptoms
- Severe pain, stable, onset 3-4 hours
- Vomiting : green or fecal
- Increase temperature
Surgical abdominal pain

Obstruction
- Invagination, bolus ascariasis,
volvulus/rotation of gaster

Inflammation
- Acute appendicitis, acute cholecystitis, peritonitis

Blood flow disturbance
- Invagination, malrotation, volvulus,
ovarian cyst torsion
Physical examination

Localized or generalized peritoneal sign
Sign of obstruction
- Abdominal distention
- Bowel contraction and peristaltic
Tumor mass
Anorectal bleeding

Therapy

Exploration/operation laparotomy

Definition (Apley, 1975)
Recurrent abdominal pain is intermittent
abdominal pain at least 3 times which
persists for longer than 3 months and
affects normal activity
Recurrent abdominal pain
Prevalence

Age 3 14 years old
mostly 5 10 years old
5% of pediatric outpatient
Organic cause 5-10%

Etiology

Organic 5-15,6% cases
Functional 80%

Di RSCM

17 cases
47% spasmophylia
11.8% gastritis
5.9% colitis
29.4% worms infection
11,8% psychological/psychiatric disorders
Symptoms suggested organic disorders
Persistent fever
Growth and development disturbance
Weight loss
Anemia
Hematemesis
Melena
Hematochezia
Pain away from midline
Perianal disease
Diagnostic approach

1. Careful anamnesis, Physical examination,
and further investigation
2. High cost examination and commonly was
not positive
3. Endoscopy greater probability to find the
etiology
Anamnesis
Age
Pain (localization , type, time, frequency, other symptom)
Defecation pattern
Urination pattern
Menstrual cycle
Skeletal muscle disorders
Growth and development disorders
Psychosocial aspect
Trauma
History of family disease
Laboratory and further investigation
Routine ( urine, blood, feces)
Ureum, creatinine
Culture
3 positions of abdominal plan photo
Thorax photo (severe disease)
Barium meal/follow through
Barium enema
Intravenous pyelography
Ultrasound
Endoscopy
Therapy

Depend on etiology
Sedative and analgesic