sakit perut akut pada anak (iii).pptx

7/27/2019 Sakit Perut Akut pada Anak (III).pptx

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ACUTE ABDOMINAL PAININ CHILDREN

SETIA BUDI SALEKEDE

Department of Child Health, Medical School, University of Hasanuddin /

Wahidin Sudirohusodo Hospital, Makassar, Indonesia


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introduction

Common problem in children Can be self limiting or an emergency

problem

ACUTEABDOMINAL PAIN

Completing clinical evaluation is important

Consider the cause of pain (age & location,surgical case/)

DIAGNOSIS

CBC, urinalysis, stool or radiologicexamination

Differential diagnosis

Referral to surgery division

INVESTIGATIONS


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D E F I N I T I O NAbdominal pain is a pain

felt between chest andinguinal region

Acute abdominalpain

Recurrentabdominal pain


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ACUTE ABDOMINAL PAIN

Abdominal pain attack episode, sudden onset,

hours a week, and never had pain before,

could be persistent or remitting pain with mild

severe intensity, consider medical

intervention and surgical intervention if

needed to solve the cause of pain.


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RECURRENT ABDOMINAL PAIN

Apley Abdominal pain minimally three

times pain episode within three months with

severe enough intensity and may influence

activity.


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INCIDENCE

79.4%

20.6%

Acute Abdominal Pain in Children

Nonsurgical cases

Surgical cases

Cerrahpasa Medical School ER, Istanbul


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INCIDENCE

23.7%

15.4%

15.4%

9.4%

8%

28.1%

Nonsurgical cases (79.4%)

URTIUnknown AAP

Gastroenteritis

Constipation

UTI

Others



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INCIDENCE

81.7%

18.3%

Surgical Cases (20.6%)

Unknown

Appendicitis



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INCIDENCE

11.8%

88.2%

Acute Abdominal Pain In Children

Surgical

Nonsurgical

Wahidin Sudirohusodo Hospital, Makassar


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INCIDENCE

44.7%17.9%

9%

6%3% 19.4%

Nonsurgical Cases (88.2%)

DiarrheaDHF

URTI

Constipation

UTI

ANSAP



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INCIDENCE

66.7%

33.3%

Surgical Cases (11.8%)

Unknown

Appendicitis



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PATHOGENESIS

Vascular Disorder

Inflammation

Obstruction

Stretching of visceral

Peritoneum

Common causes


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PATHOPHYSIOLOGY

VISCERAL PAIN

SOMATIC PAIN

REFERRED PAIN

SOURCE OF ABDOMINAL PAIN


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Visceral pain

Visceral pain fibers: Bilateral, unmyelinated,

enter the spinal cord at multiple area

Visceral pain: Dull, early onset and poorly

localized


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Parietal pain

Caused by irritation of parietal peritoneal

fibers

Parietal pain fibers: myelinated , enter specific

dorsal root ganglia

Parietal pain: sharp, intense, discrete, late

onset, and localized to a dermatome

superficial to site of the painful stimulus


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Referred pain

Pain is felt at a site away from the pathological

organ

Pain is usually ipsilateral to the involved organ


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ETIOLOGY Age of onset

Location of pain :

Intra-abdominal disorder

Extra-abdominal disorder

Onset of abdominal pain


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AGE RELATED TO ABDOMINAL PAINDIFFERENTIAL DIAGNOSIS OF ACUTE ABDOMINAL PAIN BY PREDOMINANT AGE

Birth to one year Two to five years Six to 11 years 12 to 18 years

Infantile colic

Gastroenteritis

Constipation

Urinary tract infectionIntussusception

Volvulus

Incarcerated hernia

Hirschsprung's disease

Gastroenteritis

Appendicitis

Constipation

Urinary tractinfection

Intussusception

Volvulus

Trauma

Pharyngitis

Sickle cell crisis

Henoch-Schnlein

purpura

Mesenteric

lymphadenitis

Gastroenteritis

Appendicitis

Constipation Functional

pain Urinary tractinfection Trauma

Pharyngitis Pneumonia

Sickle cell crisis

Henoch-Schnlein

purpura

Mesenteric

lymphadenitis

Appendicitis

Gastroenteritis

Constipation

DysmenorrheaMittelschmerz

Pelvic inflammatory

disease

Threatened abortion

Ectopic pregnancy

Ovarian/testicular

torsion


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PAIN LOCATION

Intra-abdominal disorder

Extra-abdominal disorder


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Intra-abdominal

disorder


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PAIN LOCATION...Extra-Abdominal Causes of Abdominal Pain

Abdominal wall ThoracicRectus muscle hematoma Myocardial infarction

GU Pneumonia

Testicular torsion Pulmonary embolism

Infectious Radiculitis

Herpes zoster Toxic

Metabolic Black widow spider biteAlcoholic ketoacidosis Heavy metal poisoning

Diabetic ketoacidosis Methanol poisoning

Porphyria Scorpion sting

Sickle cell disease Opioid withdrawal


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ONSET OF ABDOMINAL PAIN


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AGE RELATED TO CLINICAL

MANIFESTATIONS

0 3 months Commonly described as vomiting

3 months

2 years Vomiting, sudden cry and histericcry without recent trauma

2 5 years Can show abdominal pain, but not

the exact location> 5 years Can show the location and severity

of abdominal pain


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CLINICAL EVALUATION

ANAMNESIS/

HISTORY OF

DISEASE

PHYSICALEXAMINATION

INVESTIGATION


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History

Age

Pain history (Pain location, Onset, Duration)

Recent trauma

Precipitating or Relieving factor

Associated symptoms

Gynecologic history

Past history

Drugs history

Family history


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Physical examination

General appearance

Vital signs

Abdominal examination Rectal and pelvic examination

Associated signs


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Investigation

Complete blood cell count

Urinalysis & stool

Plain-film abdominal radiographs USG

Endoscopy

CT scan


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DIAGNOSIS

Age and abdominal pain location were the key

for establishing the cause of abdominal pain.

Good and complete anamnesis, physical

examination and testing could lead to

accurate diagnosis of the underlying disease

causing acute abdominal pain for optimaltherapy.

G OS S (CO O )


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CAUSES OF ACUTE ABDOMINAL PAIN IN CHILDREN

Gastrointestinal causes Rupture of the spleen Hemolytic uremic syndrome

Gastroenteritis PancreatitisDrugs and toxins

Appendicitis Genitourinary causes Erythromycin

Mesenteric lymphadenitis Urinary tract infection Salicylates

Constipation Urinary calculi Lead poisoning

Abdominal trauma Dysmenorrhea Pulmonary causes

Intestinal obstruction Pelvic inflammatory disease PneumoniaPeritonitis Ectopic pregnancy Diaphragmatic pleurisy

Food poisoning Ovarian/testicular torsion Miscellaneous

Peptic ulcer Endometriosis Infantile colic

Meckels diverticulum Metabolic disorders Pharyngitis

Inflammatory bowel disease Diabetic ketoacidosis Angioneurotic edemaLactose intolerance Hypoglycemia

Liver, spleen, and biliary tract

disorders

Acute adrenal insufficiency

Hepatitis Hematologic disorders

Cholecystitis Sickle cell anemia

Cholelithiasis Henoch-Schnlein purpura

DIFFERENTIAL DIAGNOSIS (COMMON)


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MANAGEMENT

UNDERLYINGDISEASE

TREATMENTANALGETICS?

SURGERYCONSULTATION


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R E F F E R E D

INDICATION FOR SURGICAL CONSULTATIONS IN CHILDREN WITH ACUTEABDOMINAL PAIN

Severe or increasing abdominal pain with progressive

Signs of deterioration

Bile-stained or feculent vomitus

Involuntary abdominal guarding/rigidity

Rebound abdominal tenderness

Marked abdominal distension with diffuse tympany

Signs of acute fluid or blood loss into the abdomen

Significant abdominal trauma

Suspected surgical cause for the pain

Abdominal pain without an obvious etiology


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SUMMARY

A common problem which needs aprompt diagnosis.

Age and pain location were the key for

establishing the cause of abdominal pain. The accuracy of diagnosis was needed to

provide an optimal therapy.

Sign of surgical cases should refer tosurgery division.


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THANK YOU


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SUMMARY

Acute abdominal pain in children was a commonproblem to diagnosis. Age and abdominal painlocation were the key for abdominal pain caused.

Complete anamnesis/history of disease, physicalexamination and testing could diagnosisaccurately the underlying disease acuteabdominal pain. However, the accurate of

diagnosis was needed to give an optimal therapy.If there was sign of surgery cases on acuteabdominal pain in children, we can consult tosurgery division.


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DURATION AND SEVERITY

ACUTE ABDOMINAL PAIN

h ld b


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Evidence of trauma?

Fever?

Evidence of sickle cell

anemia?

Left-sided pain

Child abuse

Accidental injury

Urinary tract infection

PharyngitisGastroenteritis

Mesenteric lymphadenitis

Pneumonia

Appendicitis

Pelvic inflammatory disease

Sickle cell crisis

Constipation

Ovarian/testicular torsion

Middle to right-

sided pain?

Appendicitis

Ovarian/testicular torsion

Mesenteric lymphadenitis


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Present in other

household contacts?

Sexually active?

Paleness/purpura?

Blood in stool?

Food poisoning

Gastroenteritis

Pelvic inflammatory disease

Ectopic pregnancy

Hemolytic uremic syndromeHenoch-Schnlein purpura

Inflammatory bowel diseaseHemolytic uremic syndrome

Henoch-Schnlein purpura

Gastroenteritis


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Evidence of

obstruction?

Refer or observe

Malrotation

Intussusception

Volvulus

Hematuria? Renal calculi

Renal trauma

Urinary tract infection

DATA PRIMER SAKIT PERUT AKUT


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DATA PRIMER SAKIT PERUT AKUT

RSU Dr. Wahidin Sudirohusodo Tahun 2010

Jumlah Kasus SPA Jumlah (%)

Total 76 (100%)

Laki-laki 43 (56.5%)

Perempuan 33 (43.5%)

Nonbedah 67 (88.2%)Diare 30 (44.7%)

DBD 12 (17.9%)

ISPA 6 (9%)

Konstipasi 4 (6%)

ISK 2 (3%)

Nonspesifik 13 (19.4%)

Bedah 9 (11.8%)

Apendisitis 3 (33.3%)

Tidak diketahui 6 (66.7%)

Total Kunjungan Pasien tahun 2010: 2060 pasien


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Cullens Sign


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Grey Turners Sign

Mi l h


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Mittelschmerz

Ovulation pain; Midcycle pain

Lower-abdominal pain that is:

One-sided

Recurrent or with similar pain in past

Typically lasting minutes to a few hours, possibly

as long as 24-48 hours

Usually sharp, cramping, distinctive pain

Severe (rare)

May switch sides from month to month or from

one episode to another

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