Swelling and swelling, why does the child always have abdominal distension?

It is only for medical professionals to read and refer to the swelling and swelling, mother and my stomach is swollen again.
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Children's abdominal swelling is a problem that plagues many parents, and it is also a common problem for children in clinics
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There are many reasons for children's abdominal distension.
How to make accurate diagnosis and differential diagnosis, prevent and treat symptomatically, is the focus of pediatricians and parents
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On October 24th, at the 26th National Pediatric Academic Conference of the Chinese Medical Association, Professor Zhang Lin from the Third Hospital of Hebei Medical University gave a wonderful report on the topic of "Diagnosis and Differential Diagnosis of Abdominal Distension in Children"! 1.
What is bloating? Abdominal distension is a common clinical symptom in children, which can be a symptom of digestive system disease itself, or an accompanying or secondary symptom of systemic disease or other system diseases
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Abdominal distension can be caused by gas accumulation in the abdominal cavity, intestinal cavity, fluid accumulation, huge intra-abdominal cysts, tumors, or abdominal muscle weakness
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Clinical abdominal distension includes two types: abdominal distension and non-abdominal distension
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▎ Abdominal distension: It is an objective manifestation of abdominal distension accompanied by an increase in abdominal circumference
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The degree of abdominal distension can be measured by abdominal circumference .

▎Non-abdominal bloating: It is a subjective feeling, that is, there is gas, retained gas, pressure or bloating, but there is no obvious visible bloating
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 2.
Why is the abdominal bloating? In clinical children, abdominal distension is mainly caused by the increase of gas in the digestive tract, and the increase of gas may be due to the following five major reasons
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1.
Swallowing a large amount of gas; 2.
Undigested food in the intestinal cavity is fermented by bacteria to produce a large amount of gas; 3.
Overgrowth of small intestinal bacteria caused by various reasons to ferment carbohydrates to produce gas; 4.
Impaired gastrointestinal transport function and sensitivity Enhancement; 5.
When respiratory failure occurs, CO2 excretion in the lungs is impeded, PCO2 in venous blood is higher than PCO2 in the intestinal cavity, and the gas diffuses into the intestinal cavity
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Considering the causes of children's abdominal distension from the perspective of etiology, there are mainly the following three aspects
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▎ Organic diseases of the gastrointestinal tract: including acute gastric dilatation, pyloric hypertrophy, mechanical or paralytic intestinal obstruction, pseudo intestinal obstruction, Hirschsprung's disease, and intestinal inflammation
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▎ outside the digestive tract lesions: include ascites, intra-abdominal tumor, systemic infection, hypokalemia, heart failure
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▎ functional gastrointestinal disorders: including food intolerance, food allergies, diaphragm coordination dysfunction, visceral reflex abnormalities, gastrointestinal motility abnormalities
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 Third, the identification of abdominal distension, the medical history is very important! Once a child has the expression of "abdominal distension", the medical history should be followed up in detail, which is particularly important for the diagnosis and differential diagnosis of the child's abdominal distension
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The following medical history needs to be inquired in detail: 1.
Age: Children have different causes of abdominal distension at different ages.
Therefore, the age of the child should be considered first.
This is the simplest but the easiest to miss
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2.
Symptoms: Whether the child has fever, vomiting, abdominal pain, diarrhea, constipation, blood in the stool, jaundice, systemic edema, dyspnea, etc.
, these often provide the basis for the differential diagnosis of abdominal distension in children
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3.
Past history: whether people with history of other diseases such as liver and gallbladder disease, severe diarrhea, a history of trauma surgery, severe infection, multiple organ dysfunction syndrome
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4.
Diet and living habits: the recent diet of the child, such as eating too much beans, peanuts, potatoes and other foods that can easily cause bloating
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 The four standard physical examinations provide diagnostic examinations based on clinical norms and provide supporting evidence for the diagnosis of children’s abdominal distension.
We cannot ignore the importance of standardized physical examinations due to time constraints or children’s crying
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■ Inspection: The whole abdomen is uniformly rounded, and obesity or gastrointestinal gas should be considered when the umbilical depression is concave; the umbilical protrusion is mostly ascites or intra-abdominal mass; localized abdominal distension such as right lower abdominal distension may be an abscess around the appendix
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■ Palpation: Abdominal muscle tension is accompanied by obvious tenderness, suggesting peritonitis; when there is a lot of ascites, there is a sense of fluctuation in the abdomen, and mobile dullness is positive
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■ Percussion: percussion drum sounds are flatulence, solid percussion sounds are solid masses; mobile dullness is ascites
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■ Auscultation: Excessive bowel sounds or high-pitched bowel sounds indicate mechanical intestinal obstruction; weakened or disappeared bowel sounds indicate intestinal paralysis
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■ Digital rectal examination: watch for anorectal stenosis, rectum and pelvic mass, after examination whether the gas will be discharged, whether the blood-stained finger and so on
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Five diagnosis points of abdominal distension in children 1.
Different ages have different causes of abdominal distension.
Newborns and small babies should consider gastrointestinal malformations, pyloric obstruction, Hirschsprung's disease, and serious infections
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2.
Food factors such as excessive intake of beans, peanuts, and potatoes can easily cause abdominal distension
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If there is lactase deficiency, ingestion of dairy products can cause abdominal distension
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3.
According to the accompanying symptoms, such as vomiting, diarrhea, constipation, abdominal pain, jaundice, edema, lumps, etc.
, should be carefully analyzed
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4.
Pay attention to the shape of the child's abdominal distension: ① The whole abdominal distension is uniformly raised and the umbilicus is sunken.
Obesity or gastrointestinal bloating should be considered.
If the umbilicus is protruding, it is mostly ascites or intra-abdominal mass
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② If the upper abdomen is swollen, the umbilical cord moves downward; the upper right abdomen is more frequent with hepatobiliary enlargement; the upper middle abdomen is more common with gastrointestinal diseases; the upper left abdomen is often caused by splenomegaly; the waist swelling can be kidney or lumbar hernia; Lower abdominal distension is more common in urinary retention; right lower abdominal distension may be an appendix abscess
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Figure 1: The diagnosis process of children's abdominal distension (from the lecturer's courseware) 6.
How to differentiate and diagnose children's abdominal distension? 1 Intussusception is common in infants and young children, and mostly occurs in children under 2 years of age
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It manifests as paroxysmal abdominal pain, vomiting, and can discharge jam-like, dark red or bright red bloody pus and blood in the stool
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A salami-like mass can be palpable in the abdomen, and bowel sounds can be heard on auscultation.
When intestinal perforation peritonitis occurs in the late stage (48 hours later), the abdominal distension increases, the abdominal muscles are tense, the tenderness is obvious, the abdominal wall veins are dilated, and even ascites symptoms appear
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Imaging examination: Barium enema showed cup-shaped, clamp-shaped, spherical cylindrical shadows in the colon under X-ray fluoroscopy; abdominal ultrasound examination; the cross-section of the intussusception showed a "concentric circle" or target ring Block shadow, the longitudinal section shows a "sleeve" block shadow
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2 Congenital hypertrophic pyloric stenosis is an upper gastrointestinal insufficiency obstruction caused by pyloric lumen stenosis caused by hypertrophy of the pyloric circular muscle
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Symptoms often appear 2 to 6 weeks after birth, mainly manifested as vomiting a few minutes after breastfeeding, localized flatulence in the upper abdomen, and sunken or flat lower abdomen
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During physical examination, a jujube pit or olive-sized mass can be palpated at the deep junction between the outer edge of the right rectus abdominis muscle and the lower right costal margin.
It is smooth, hard as cartilage, and can move
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Imaging examination: X-ray examination of barium showed hyperperistaltic waves, retention of barium in the stomach, hypertrophy of the anterior and posterior walls of the pyloric duct, and slender pyloric duct
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3 Congenital Hirschsprung's colon system has no ganglion cells in the distal colon, and bowel movement dysfunction.
Fecal siltation in the proximal colon leads to the enlargement and hypertrophy of the intestinal tube and the formation of Hirschsprung's colon
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It is manifested as delayed meconium discharge after birth, intractable constipation, abdominal distension, vomiting, malnutrition and developmental delay
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Digital rectal examination discharges foul gas and stool
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Imaging examination: Barium enema can show the "funnel shape" of typical spasticity, transitional and dilated segments
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4 Irritable bowel syndrome is chronic and recurrent attacks caused by multiple factors, mainly intestinal dysfunction, and bowel dysfunction syndrome without organic disease
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Factors involved in genetic, environmental, psychological, social and gastrointestinal infections as a result of changes in gastrointestinal motility, brain - gut axis interaction disorder, autonomic nervous and hormonal changes
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The main complaints are abdominal pain, bloating, diarrhea, and constipation, accompanied by systemic neurosis symptoms
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The general condition is good.
The physical examination only has tenderness in the abdomen.
He has performed routine routine several times and has no abnormalities in culture
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5 Pediatric intestinal failure due to intestinal resection or functional impairment leads to limited digestion and absorption of nutrients, and the symptoms are mainly diarrhea, water and electrolyte imbalance, and nutrient absorption or metabolism disorders
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Including short bowel syndrome, gastrointestinal motility disorders such as pseudo intestinal obstruction, congenital enterocytosis (microchorion disease or tufted bowel disease) and so on
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The most common underlying disease of intestinal failure is necrotizing enterocolitis
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Complications include water and electrolyte imbalances, malabsorption of nutrients, small intestine dyskinesia and bacterial overgrowth, and liver disease related to intestinal failure
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Children's abdominal distension is clinically common but not simple
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Clinical diagnosis and treatment requires multidisciplinary collaboration such as internal medicine and surgery
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Improve the understanding of children's abdominal distension and avoid missed diagnosis and misdiagnosis
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