hafiz usman warraich roll c gi disorders in children l.
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Hafiz Usman Warraich Roll#C GI Disorders in Children. Dr Shreedhar Paudel 24/03/2009. Approach to a Child With Abdominal Pain. Acute abdominal pain Causes Surgical causes (children of ≤ 2 yrs age) - Malrotation - Intussusception - Necrotising enterocolitis

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approach to a child with abdominal pain
Approach to a Child With Abdominal Pain
  • Acute abdominal pain


Surgical causes (children of ≤ 2 yrs age)



-Necrotising enterocolitis

-Incarcerated inguinal hernia



causes of ac abd pain
Causes of Ac Abd Pain…
  • Medical causes (≤ 2 yrs age)
    • Gastroenteritis
    • UTI
    • Basal pneumonia
    • Hepatitis
    • Spontaneous bacterial peritonitis
causes of ac abd pain4
Causes of Ac Abd Pain…
  • Surgical causes(children of ≥ 2 yrs age)
    • Appendicitis
    • Intestinal obstruction
    • Meckel’sdiverticulum
    • Peritonitis
    • Cholecystitis
    • Incarcerated inguinal hernia
    • Trauma
causes of ac abd pain5
Causes of Ac Abd Pain…
  • Medical causes(children of ≥ 2 yrs age)
    • Worm infestation
    • Gastroenteritis
    • Hepatitis and liver abscess
    • UTI
    • Primary peritonitis
    • Pancreatitis
    • HSP
    • Ischemic bowel disease
    • Mesenteric lymphadenitis
    • Lead poisoning
chronic recurrent abdominal pain
Chronic & Recurrent Abdominal Pain
  • Recurrent or persistent bouts of abdominal pain that occurs over a minimum of 3 months.
  • Types:- Organic abdominal pain

- Non organic abdominal pain

treatment of functional abdominal pain
Treatment of functional abdominal pain
  • Organic causes should be excluded
  • Assurance of parents: absence of major illness
  • Child psychologists for management
  • Pain may be relieved by anticholinergic agents
causes of chronic and recurrent abdominal pain
Causes of chronic and recurrent abdominal pain
  • Children < 2yrs :

-Colic- uncontrollable crying in a baby that has no known cause.

- Malabsorption

-Milk allergy

-Rotational defects

-Hirschprung disease


causes of chronic and recurrent abdominal pain11
Causes of chronic and recurrent abdominal pain
  • Children > 2years:

-functional pain



-intra-abdominal abscess

-lead poisoning



-intestinal parsites

case 1
Case 1
  • 11 yrs old child with h/o abdominal pain for 2 mo—no associated symptoms

--pain not localised

What is the diagnosis?

case 2
Case 2
  • 4 yrs male child, with

--abdominal pain-4 days

--nausea, vomiting, headache



--no diarrhoea

--continuous pain

What is the diagnosis?

case 2 contd
Case 2 contd….
  • Site of pain– Rt upper quadrant
  • Cough ???– to r/o basal pneumonia
  • Not functional pain coz fever present
  • D/D

--Hepatitis—subclinical infective hepatitis—call after 3-4 days yellow sclera will be obvious.

--Liver abscess

case 3
Case 3
  • 18/12 yrs female child,

--winter month

--excessive crying and vomiting—severe abdominal pain suspected

--mild fever 2 days back with running nose

--stool 2-3 times a day with blood

What are D/Ds?

gastro oesophageal reflux
Gastro-oesophageal reflux
  • Common—neonates and early infancy
  • 1st week of life incidence—85%
  • Declines to 6% by 2 months
  • Manifested as recurrent history of vomiting
  • Management

--not required unless child looses weight and develops recurrent aspiration pneumonia

--keep child upright after each feeding

congenital pyloric stenosis
Congenital Pyloric Stenosis
  • Manifests in neonatal period
  • More common in 1st born males
  • Projectile vomiting—2nd week after birth
  • Mass—firm and round palpable in the epigastrium with visible peristalsis L→R (as condition progresses)
  • If not treated early—dehydration with electrolyte imbalance
congenital pyloric stenosis contd
Congenital Pyloric Stenosis contd…
  • Treatment:

--Rammstedt’s operation- choice

--feeding after few hours of operation

--electrolyte, dehydration and alkalosis must be corrected before the operation

  • A portion of the alimentary tract is telescoped into a segment just caudal to it.
  • Frequently misdiagnosed as desentry in infancy and early childhood
  • Usually healthy children
  • Cases may coincide with outbreaks of adenoviral infections
intussusception contd
  • Clinical features:
    • Child around 1 yr of age presents with acute onset
    • Vomiting
    • Severe colicy abdominal pain
    • Episodic excessive crying
    • Attacks at varying interval of time
    • Followed by stool containing blood and mucus (Red currant jelly)
intussusception contd23
  • Sausage-shaped mass lying transverse across the abdomen with features of acute abdominal obstruction
  • Rt iliac fossa may appear empty
  • DRE (digital rectal examination)—tip of intussusceptum
intussusception contd24
  • Investigations:

--USG abd-100% diagnostic for an expert eye

--Barium enema X-Ray film—Claw sign

Cupping (as obstructed by the intussusceptum)

So pressure may reduce obstruction

intussusception contd26
  • Treatment:

--surgical emergency

--treatment of shock and rehydration

--if it’s of short duration hydrostatic pressure of barium enema may relieve intussusception but not so in ileoilialintussusception.

gi allergy
GI Allergy
  • Example– allergy to cow’s milk protein in the first few months of age
  • Clinical features may be
    • Diarrhea
    • Nausea
    • Vomiting
    • Abdominal pain
gi allergy29
GI Allergy…
  • 3 main factors responsible are
    • Genetic predisposition
    • Allergen exposure
    • Contributory factors
      • Immunological defects
      • G I diseases
      • Infections
      • Non specific irritants
management of gi allergy
Management of GI Allergy
  • Find out the allergen
  • Avoid the exposure to allergen
  • Desensitization may be the last resort