Intestinal cramps

Introduction Intestinal fistula is a paroxysmal abdominal pain caused by a strong contraction of the smooth muscles of the intestinal wall, which is the most common condition in children with acute abdominal pain. In small babies, you can know if there is intestinal cramps from the degree and intensity of crying. In small babies, the onset of intestinal fistula is mainly characterized by persistent, difficult to appease crying. The main manifestations are crying and uneasiness, which may be accompanied by vomiting, cheek flushing, tumbling, and distortion of both lower extremities. When crying, the face is flushed, the abdomen is inflated and tense, and the legs are lifted up. The attack can be terminated by the child's exhaust or defecation. In small babies, it can be repeated and self-limited.

Cause

First, the gastrointestinal factors.

(1) Excessive intestinal gas production.

There are four major sources of intestinal gas: swallowed gas, neutralized gastric acid production, diffused from the blood, and bacterial fermentation.

(2) Increased intestinal motility.

(three) gastrointestinal hormones.

(4) Dietary factors. Some studies have shown that intestinal fistula in breastfed infants is associated with maternal drinking milk, and food allergies may be a cause of intestinal spasms.

(5) Other factors.

Second, non-gastrointestinal factors.

an examination

Related inspection

Abdominal plain film routine routine

First, physical examination

Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.

Second, laboratory inspection

Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis. Such as: blood routine, routine, biochemical, and peritoneal.

Differential diagnosis

(1) Diseases that often need to be identified

1, intussusception:

It is a disease that should be identified first in infants and young children. It is a fat male infant who occurs in 4 to 10 months. It can occur in the whole year and peak in spring. Typical clinical manifestations include paroxysmal crying, vomiting, abdominal sausage-like masses, and jam-like (blood) stools. Paroxysmal crying is caused by the intussusception of the intussusception, which is often more severe and regular than the simple intestinal fistula. Vomiting occurs almost in every intussusception, and simple intestinal fistula is less common. Most children have access to abdominal sausage-like masses, usually located along the colonic frame, half of which are located in the right upper abdomen. The mass is larger than the intestine that is touched by the intestinal tract, and has some elasticity and tenderness. Jams may be discharged after more than 6 hours of onset. Gas or barium enema can confirm clinical diagnosis (except rare intussusception) and can be used to try intussusception by increasing the pressure of the intestine.

2, acute appendicitis:

Acute suppurative appendicitis occurs mostly in children over 5 years of age, but it is not impossible in infants and young children. The typical symptom of appendicitis is metastatic right lower abdominal pain. In the early stage of the disease, the child often reports self-abdominal or upper abdominal pain, and some can not determine the abdominal pain. At this time, it can be confused with intestinal fistula. After a few hours, the abdominal pain is mostly fixed in the right lower abdomen. Abdominal pain is generally persistent, but appendicitis with obstructive properties such as fecal stone obstruction and parasites in the appendix can be mainly paroxysmal and spastic pain for a period of time, and should also be differentiated from intestinal fistula. The main point of identification is that all types of appendicitis must have fixed tenderness in the right lower abdomen. The disease may be slightly longer and may have muscle tension, which is different from intestinal fistula. Sometimes it takes several checks to determine if the tender point is fixed. In addition, appendicitis is often accompanied by early nausea, vomiting, and later fever and increased white blood cells.

3. Acute gastroenteritis or intestinal infection:

It can occur in children of all ages. In addition to paroxysmal abdominal pain, symptoms such as vomiting, diarrhea and fever may occur, and dehydration may occur due to vomiting and diarrhea. All of the above are not typical manifestations of intestinal fistula, but the initial stage of the disease still needs to be differentiated from intestinal fistula. Intestinal infections, including bacterial dysentery and amoebic dysentery, should be diagnosed in conjunction with laboratory tests of stool.

4, mesenteric lymphadenitis:

Children are more common and generally have a history of upper respiratory tract infections. The child often reports self-reported faint abdominal pain, which is paroxysmal. Sometimes it is not possible to determine the location of abdominal pain, and often the right lower quadrant pain, because the mesenteric membrane is rich in lymphoid tissue. Physical examination may have tenderness in the right lower quadrant, but the tender point is not fixed, nor is it accompanied by muscle tension. Do not forget to check the throat and lungs of the child for suspected mesenteric lymphadenitis.

5. Intestinal ascariasis and biliary mites:

Abdominal pain caused by intestinal ascariasis is actually a bowel pain, and it is paroxysmal, sometimes vomiting and abdominal tenderness, it is difficult to touch the mites. Although the disease is similar to the clinical manifestations of intestinal fistula, it is also determined to be identified because of different treatment methods. The typical clinical manifestation of biliary mites is severe paroxysmal abdominal pain. The upper right side of the upper abdomen is the most important pain, which may be accompanied by local tenderness and muscle tension. Biliary locusts are sometimes associated with intestinal ascariasis and should be noted. The locust complication is related to the national health conditions and living habits, so the diagnosis must be combined with medical history. Although the disease has decreased in recent years, it is still a common disease in rural areas with poor sanitation.

6, constipation:

Chronic constipation generally does not cause abdominal pain, but constipation caused by temporary causes can often induce sigmoid colon fistula and paroxysmal abdominal pain. This disease occurs mostly in children. Abdominal pain is often in the lower abdomen or to the left, sometimes touching the gut tube or dry hard stool block. Abdominal pain can often be relieved or disappeared after enema with Kaisailu or soapy water. In addition, infants and even newborns sometimes cry before defecation, crying after defecation, whether the bowel spasm is caused by local stimulation of the stool or nerve reflexes.

(2) Other diseases that need to be identified

Surgical: intestinal torsion of the sacral kidney and ureteral calculi, superior mesenteric artery compression syndrome.

Internal medicine: biliary tract abdominal type, allergic purpura abdominal type, epilepsy porphyria and other related diseases should even notice abdominal pain caused by lobar pneumonia and pericarditis.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.