Durerea Abdominala Ac Si Cr

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  • DUREREA ABDOMINAL ACUT LA COPIL

  • Etiologia durerilor abdominale acute la copil n funcie de vrst (dup Lieh-Lai, 2002, Kliegman, 2003)Nou-nscutobstrucie morfologic la diferite nivele: duplicaiile intestinale, atrezie, stenoze.obstrucie funcional: achalazie -stenoza piloricamegacolon congenitalileus meconial (frecvent ca manifestare precoce a fibroza chistic de pancreas)enterocolita ulceronecrotic (premature, hipoxie la natere + infecie)malrotaie intestinal cu volvulus -invaginaie intestinalidiopatic sau prin medicamente (indometacin-nchidere PCA, steroizi)pot induce perforaii intestinaletraumatisme abdominale in timpul travaliului si a asistentei la natereSugar gastroenterit acut -apendicita -diverticul Meckelrefluxul gastroesofagian -esofagitmalrotaie cu volvulus intestinal -invaginaieinfecie tract urinar -obstructie uroteropielicatraumatism abdominalaerofagie -boala Hirschprungperitonita spontana bacterianahepatit -tumoricolicile nou-nscutului i sugarului mic

  • Copil 2-11 ani -apendicita -gastroenterita - traumatism -purpura Henoch-Schonlein -sindrom hemolitic uremic -hepatita -boala ulceroasa peptica -pneumonie (lob inferior) -faringita/amigdalita -faringita streptococica -tumori abdominale -pielonefrita/cistita -torsiune testicul -hernie incarcerata -diverticulita Meckel -sdr.artere mezenterice superioare -adenita mezenterica -acidocetoza diabetica -idiopatica Adolescent -gastroenterita acut -apendicita -boala ulceroasa peptica -boala inflamatorie pelvin -abces tuboovarian -chist ovarian -boala inflamatorie a intestinului subtire -adenita mezenteric -colecistita + litiaza biliar (anemii hemolitice !) -neoplazii -pancreatita acuta -hepatita -diverse:-dureri abdominale functionale -dismenoree -sarcina ectopica -pielonefrita -litiaza urinara -traumatism torsiune de ovar, testicul -acidocetoza diabetica -idiopatic

  • Cauze sistemice de dureri abdominale (Kliegman, 2003)

    Metabolice / hematologiceporfirie acut edem angioneurotic ereditar criza de sicklemieleucemii hemolize acuteacidocetoza diabetic boala Addisonhiperparatiroidism/hipercalcemie cu producere de litiaz urinarsindrom hemolitic-uremic Uremie Tulburri electroliticeHipertrigliceridemie (pancreatita)

    Neurologice epilepsie abdominala (diagnostic de excludere, EEG, eficacitate terapie anticomitiala)migrena abdominala tumori cerebraleScleroza multipla radiculopatii neuropatiiherpes Zosterdisautonomie(Sdr.Riley Day)

    Musculoscheleticeartrita/discopatii osteomielitadisfuncii la nivelul rdcinilor nervoasetraumatism hernieabces/hemoragie/psoas

  • Cauze sistemice de dureri abdominale(2) Medicamente/toxiceIntoxicaii cu metale grele(Pb, As, Hg)Intoxicaii ciuperciOprire narcoticeIneptura insecte (vduva neagr)

    Inflamaii/InfeciiRAAMononucleoza infecioas febra patat a Munilor Stncoi Rujeola parotidita epidemicapneumonie de lob inferior faringita pericarditaepididimita/orhitaPurpura Henoch-Schonlein Sindrom hemolitic-uremicLES anafilaxieEndocardita

    Diversepneumotorax embolie pulmonara Aerofagie Funcional

    40% din durerile abdominale acute sunt nespecifice (Marx Rosen).

  • Cauze extra-abdominale de durere abdominal (dup J.A.Marx et al Rosens emergency Medicine, Ed.Mosby Philadelphia 2006)

    1. Toracic -Infarct miocardic (rar la copil) -pneumonie -embolie pulmonara -neuralgie

    2. Genitourinar -torsiune testiculara/ovariana

    3. Perete abdominal -spasm muscular -hematom muscular -herpes Zoster

    4. Infecii -faringita streptococica -mononucleoza

    5. Sistemic -acidocetoza diabetica -Uremie -porfirie -sicklemie -LES -Vasculite -glaucom -hipertiroidism

    6. Toxic -intoxicatie cu methanol, metale grele, muscatura sarpe

  • Gastrointestinal causes Gastroenteritis Appendicitis Mesenteric lymphadenitis Constipation Abdominal trauma Intestinal obstruction Peritonitis Food poisoning Peptic ulcer Meckels diverticulum Inflammatory bowel disease Lactose intolerance Liver, spleen, and biliary tract disorders Hepatitis Cholecystitis Cholelithiasis Splenic infarction Rupture of the spleen PancreatitisGenitourinary causes Urinary tract infection Urinary calculi Dysmenorrhea Mittelschmerz Pelvic inflammatory disease Threatened abortion Ectopic pregnancy Ovarian/testicular torsion Endometriosis Hematocolpos Metabolic disorders Diabetic ketoacidosis Hypoglycemia Porphyria Acute adrenal insufficiency Hematologic disorders Sickle cell anemia Henoch-Schnlein purpura Hemolytic uremic syndrome Drugs and toxins Erythromycin Salicylates Lead poisoning Venoms Pulmonary causes Pneumonia Diaphragmatic pleurisy Miscellaneous Infantile colic Functional pain Pharyngitis Angioneurotic edema Familial Mediterranean fever Causes of acute abdominal pain in childrenA.K.C. LEUNG Acute Abdominal Pain in Children AMERICAN FAMILY PHYSICIAN 2003, 67,11:2321-2326

  • Evaluare copilului cu durere abdominala.I. Anamneza (Behrman, Lieh Lai, Marx Rosen)*timpul de la debutul durerii sub 6 ore, de obicei date nespecifice=necesita observare n continuare ntre 6 i 48 ore: mai uor de gsit o cauza i a nu ntrzia dac este chirurgical.*varsta pacientilor la debut *Localizare, recrudescenta, *intensitate, caractere, durata *Iradiere *eventual traumatism II. Sediul durerii: sediul durerii abdominale la debut schimbarea sediului / generalizare Cadranul superior drept-pleurezie/pneumonie, infarct pulmonar -abces subdiafragmatic-perihepatita (Sdr.Fitz Hugh-Curtis), hepatita abces, neoplazie, traumatism, congestie hepatica (ex.in Insuficienta cardiaca, pericardita)-colecistita,litiaza biliara-ulcer duodenal gastric perforat , stenoza pilorica, hernie hiatala-obstructie intestinala -apendicita retrocecala-sarcina ectopica, hemoragie tubovariana, abces sau ruptura-perforatie colica diverticul Meckel, cancer -herpes Zoster-Cardiac: pericardita, infarct/ischemie-Renal: infectie, calculoza, neoplazii, ruptura-pancreatita, neoplazie, calculi in canalul pancreatic sau ampula Valter-traumatism

  • Cadranul superior stg.-pleurezie/pneumonie,infarct pulmonar cu sediul stg.-ruptura/infarct splenic, abces splenomegalie-perforatie ulcer gastric -pancreatita, neoplazii, calculoza-diverticulita (la unghiul splenic), perforatie colica-sarcina ectopica, hemoragie tubovariana, abces sau ruptura-perforatie colica (carcinom)-zona Zoster -infarct miocardic,angina pectorala -ruptura anevrism Ao-calculoza renala / ureterala, pielonefrita, neoplazii Cadran inferior drept-apendicita -forma acuta a bolii Crohn -abces psoas-sarcina ectopica,hemoragie tubovariana,abces sau ruptura-boala inflamatorie pelvina-diverticulita cecala, perforarea cecului, obstructie cecala-cancer colon (perforatie)-pancreatita acuta / pseudochist -perforatie ulcer duodenal-colecistita -hernie inghinala strangulata -diverticul Meckel-traumatism Cadran inferior stang-diverticulita sigmoidiana, obstructie intestinala-boala inflamatorie pelvina-sarcina ectopica, hemoragie tubovariana, abces sau ruptura-perforatie carcinom sigmoidian-perforatie ulcer gastric, boala inflamatorie intestinala -hernie inghinala strangulata-renal: calculoza,pielonefrita,neoplazie-anevrism disecant Ao

  • Alte sedii ale durerii abdominale (Marx Rosen) Epigastric-boala ulceroasa peptica,obstructie evacuare gastrica,ulcer gastric-boala ulceroasa duodenala, duodenita -colecistita,litiaza biliara-pancreatita -obstructie inalta intestin subtire, debut apendicita-suferinta cardiaca: pericardita, infarct miocardic/angina(rare la copil)-pulmonar: pneumonie lob inferior,pleurezie, pneumotorax -abces subfrenic-anevrism disecant de Ao, ischemie miocardica Periombilical-obstructie/gangrena intestin subtire -debut apendicita-tromboza mezenterica