Syndromes in gastroenterology

Abdominal pain syndrome: groups of causes

Based on mechanism and origin, all causes of abdominal pain in children are traditionally divided into five major groups:

1. Functional (non-organic). These include irritable bowel syndrome (IBS), functional dyspepsia, and functional constipation.
2. Organic. Associated with actual tissue damage: peptic ulcer disease, gastroduodenitis, pancreatitis, cholecystitis, as well as ulcerative colitis and Crohn's disease.
3. Surgical. Pathologies requiring emergency care ("acute abdomen"): appendicitis, intussusception, acute intestinal obstruction.
4. Infectious. Caused by pathogens: campylobacteriosis, yersiniosis, escherichiosis, as well as parasites (giardiasis, ascariasis).
5. Extra-abdominal (somatic). Pain radiates to the abdomen in other diseases, such as aortic coarctation, Kawasaki disease, Bornholm disease, or acute adrenal insufficiency.

Functional gastrointestinal disorders

These are conditions where clinical symptoms are present, but structural, infectious, or metabolic changes are absent. They are based on a failure of neurohumoral regulation of visceral sensitivity and motility.

According to the Rome IV criteria, the spectrum of disorders is strictly divided into two age groups:

• Neonates and infants: colic, regurgitation, dyschezia syndrome, and infant diarrhea are typical.
• Older children and adolescents: functional nausea, aerophagia, and abdominal migraine predominate.

The top three most frequent diagnoses in pediatrics:

• Functional dyspepsia. Occurs in two main clinical variants: postprandial distress syndrome and epigastric pain syndrome.
• Irritable bowel syndrome (IBS). A chronic disorder in which pain is strictly associated with changes in the frequency of defecation. The diagnosis is made if pain occurs $\ge$4 days per month over the last 2 months. An important nuance: in IBS with predominant constipation, pain is not relieved even after stool has normalized.
• Functional constipation (constipatio). Manifests as infrequent defecations, hard stools, and a feeling of incomplete evacuation. Constipation can be primary (idiopathic) or secondary (against the background of endocrine or neurological pathology).

Functional disorders of the biliary system (gallbladder — vesica biliaris) are singled out separately. Dyskinesias lead among all GI pathologies, and girls are affected more often.

Rules for taking anamnesis

In addition to complaints of pain, the child often exhibits chronic intoxication syndrome: asthenia (weakness, rapid fatiguability) and neurotic shifts (tearfulness, poor sleep).

During the interview, it is necessary to collect two blocks of information in detail:

1. History of present illness (Anamnesis morbi). The onset of symptoms, cyclicity of exacerbations, and triggering factors (how dietary changes affect well-being) are ascertained.
2. Past medical history (Anamnesis vitae). The physician assesses the perinatal background, past infections (especially acute intestinal infections), nutritional status (feeding pattern from birth), allergic reactions, and the family's hereditary predisposition to digestive diseases.

Physical examination: what to look for

Examination (Status praesens) helps determine the severity of the condition and external stigmata of gastroenterological pathology.

• General appearance and posture: with severe pain, the child assumes a forced (antalgic) posture, pressing bent legs to the abdomen.
• Skin and mucous membranes: color is assessed (pallor, jaundice), along with the presence of scars, telangiectasias, or an expanded venous network on the abdomen — the "caput medusae" sign (caput medusae).
• Examination of the oral cavity: is always performed at the very end of the examination, as it causes anxiety and a negative reaction in children. The physician checks the lips for cracks and angular cheilitis, evaluates tongue moisture, and looks for specific signs — aphthae, foci of leukoplakia, or Koplik spots on the buccal mucosa.

Class and exam questions

What else to study on this topic

• Alarm symptoms (red flags) in constipation syndrome
• Clinical variants of functional dyspepsia
• Classification and types of laxatives
• Differential diagnosis of primary and secondary constipation
• Functional disorders of the biliary system in girls

Other topics in the "Additional Topics" section

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