Atan Baas Sinuhaji

Department of Childhood,School of
Medicine,University of North Sumatera
Medan
 CLASSIFICATION OF
ABDOMINAL PAIN
1.ORGANIC/ANORGANIC
2.ACUTE/CHRONIC (RECURRENT ABD.
PAIN : 1X/MONTH 3 MONTHS)
3. CONTINUE/INTERMITTENT
4. SPASMODIC/NON SPASMODIC
5.SOURCE
6. AFFERENT FIBERS
7. SURGERY/MEDICAL
 OUT OF REFERRED PAIN

ABDOMINAL (eg. PLEURITIS)

SKIN
SOURCE PARIETAL MUSCLE

ABDOMINAL PARIETAL PERIT.

VISCERAL PERIT.
VISCERAL
.
VISCERAL ORGAN

NB. STIMULATION WITH COUNTERIRRITANTS AT THE SKIN OVER AN

THE AREA OF VISCERAL INFLAMMATION PRODUCES SOME RELIEF
OF PAIN . SOURCE IS NOT CLEAR
 CAUSES OF VISCERAL ABD. PAIN

1. INFLAMMATION
2. OBSTRUCTION
3. METABOLIC
4. BLEEDING
5. CONGESTION
6. DYSMOTILITY
7. ULCER
 1.GASTROINTEST. TRACT

OBSTRUCTION

2.GENITOURINARY TRACT

HOLLOW
ORGAN 3.BILIARY TRACT

4. PANCREAS
 AFFERENT FIBERS

A FIBERS C FIBERS

PARIETAL VISCERAL
--SLOW/DIFFUSE
--POORLY LOCALIZED
--MID-LINE
--MOVEMENT
--COLIC

NB. IF APPENDICITIS CHILD HAS BRIGHT SHARP LOCALIZED PAIN

INVOLVED PARIETAL PERIT. IMPENDING PERFORATION
 NERVE FIBERS

A B C
- SENSORIC - PREGANGLIONIC - SENSORIC &
& MOTORIC AUTONOMIC POST GANGL.
SYMPHATETIC
- DIAMETER - DIAMETER - DIAMETER
LARGE MODERATE SMALL
- CONDUCTIVE - CONDUCTIVE - CONDUCTIVE
FAST MODERATE SLOW
 COLIC

INFANTILE ADULTS

< 3 MONTHS
SPASM

CRYING

3 HOURS/DAY WESSEL’S
RULE OF
3 DAYS/WEEK
THREE
3 WEEKS
 ELECTIVE POLYPS PEUTZ JEGHERS SYNDR.

SURGERY
INVAGINATION

ACUTE PERFORATION
ABDOMEN
VOLVULUS

DIGESTIVE TRACT GE
ULCER
ASCARIASIS
MEDICAL
CONSTIPATION

OUT OF DIGESTIVE TRACT

- URINARY TRACT INFECTION

-SALPHINGITIS
-PNEUMONIA
- SPINAL NERVE COMPRESSION
 DOMINANTLY INHERITED

ABDOMINAL PAIN

PEUTZ JEGHERS
SYNDROME MUCOCUTANEUS JUNCTION
PIGMENTATION

POLYPS OF GI
TRACT
 ABDOMINAL PAIN

ACUTE CHRONIC

WELL
NOT LOOKING WELL

-FUNCTIONAL
ACUTE ABDOMEN - ELECTIVE SURGERY

MEDICAL
 Atan Baas Sinuhaji
Department of Childhood,School of
Medicine,University of North Sumatera
Medan
 Disorders of ingestion

Poor Sucking Painful Difficulty

swallowing swallowing
= Dysphagia
= odinophagia

stomatitis
 Dysphagia

Motility disorders structural

= function
Anatomical Obstruction

• Schizis Ext Int.

Dysmotility
• Pierre
Robin syndr. • Stenosis
• Webs
Oroph Esoph • Stricture
• Tumor
 Recurrent Resp. Tr.
Infection
COMPLICATION

PCM
 Stomatis

ANGINA
VITAMIN 
PLAUT
VINCENT
VIRAL CANDIDA
ALBICANS
• Herpes
•Herpangina
Thrush

a-

Moniliasis
 MONILIASIS

WHITE PLAQUE

INFLAMMATION

• Bottle feeding
• Steroids
• Antibiotics
Th
• Gentian violet 1%
• Nystatin Nymiko®
 ESOPHAGEAL STRICTURE

CAUSTIC AGENT
ACID ALKALI

Bitter
Neutral
Less be consumed
More be consumed

Coagulum Necrosis Liquefaction necrosis

Stomach Deep Penetration

Th
Caustic ingestion

A. ACUTE 1. Vomiting shoul not be induced

2. Neutralizing agent shouldn’t be given
3. Nasogastric tube shouldn’t be inserted
4. Clean water
5. Corticosteroid  stricture ??

B. CHRONIC / COMPLICATION  stricture 

dilatation