Emergency Paediatric Surgery :

• Pain abdomen
  
  
• Intestinal obstruction
  
  
• Constipation, abdominal distension
  
  
• Bleeding per rectum
  
  
• Appendicitis
  
  
• Urinary tract infection

 

 

 

 

Causes of Recurrent Abdominal Pain :

 

Abdominal pain is serious and a very common problem. Commonly known as stomach aches, the treatment is generally symptom based. The symptoms of abdominal pain are commonly found in school going children. It is a discomfort in which children faces pain from the lower chest to distal groin. The pain can be dull, cramps and may be sharp. The main cause of abdominal pain is constipation. The recurrent pain in abdomen is very common in children. This is not a serious problem, but should be prevented than cured. The most common symptoms, causes and prevention are discussed below in the article.

 

Symptoms of Recurrent abdomen pain:

 

	One of the reasons for constant abdomen pain can be due to the body’s inability to digest food. Indigestion and formation of gas causes recurrent abdominal pain. Another symptom and reason behind abdomen pain could be the inability to pass stool. Constipation is quite common in children and major cause of recurrent abdominal pain. Chronic or severe diarrhoea.

 

 

How can you conclude the real reason behind recurrent abdominal pain :

 

A stool test can be conducted to know the reason behind the pain like lactose intolerance or amoebiasis or worms. Ultrasonography of the abdomen should be done to rule out any other pathology like mesenteric lymphadenitis. Diagnostic laparoscopy can be done if recurrent abdominal pain persists even after dietary modification, treating the constipation and deworming the child.

 

How can you treat recurrent abdominal pain:

 

There are many ways to treat recurrent abdominal pain as discussed in the first paragraph, the treatment depends on the symptoms and intensity, according to which the treatment is chosen and corrective measures are conducted.

 

Some of the general treatment includes:

Dietary Modifications: Child should avoid spicy feeds, oily feeds, fast food, milk products except curd, chocolates etc. Child should be encouraged to have fruits and vegetables with high fibre content. Pharmacological therapy: Anti-spasmodics should be given if pain is severe. Laxatives if constipation persists even after taking high fibre diet. Pre and Probiotics should be added. A course of antibiotics should be given if symptoms and signs are suggestive of colitis. Pizotifen has been found as a prophylactic medicine but not much evidence of use in children. Cognitive-Behavioural Therapy: This is a non-surgical corrective method, in which the patient is counselled and his behaviour is analyzed thoroughly and then corrective measures are suggested to get rid of the pain.

 

 

Swelling Penis :

 

Phimosis, Paraphimosis are the two major issues which occur in males.

In Phimosis, the foreskin is not easily pulled back from the tip position of the penis. Normally, this problem takes place in younger children and this is not a serious condition. With spontaneous erections and natural manipulations, more than 90% of foreskin becomes retractable by age 3 to 4 years. Few require Preputioplasty and Circucision is reserved for Balanitis Xerotica Obliterans.  Paraphimosis, is quite a painful condition which needs to be treated urgently. Paraphimosis is the condition in which the foreskin is pulled back or get stuck in the same position.  Due to this the retracted foreskin, as well as the penis part, becomes swollen. In this condition, the fluid will build up, and thus the foreskin cannot be returned to its original position. If anyone ignores it then it can lead to major issues. This can have an effect on blood flow to the tip of a penis. And, if not treated on time then the tip of the penis can get damaged.The insect bite is a condition which can cause swelling of the phallus and prepuce. This can be easily treated by medicine.

 

Differential diagnosis
Penile edema, which is related to insect bites, allergic reactions, and trauma.

 

Causes of Phimosis and Paraphimosis:

 

Scar tissue: Any kind of infections can create the scratch marks on the foreskin. This can also affect the penis. Thus because of tough tissues, it is somewhat difficult to pull it back. Pull and stretch: It is important that one should not forcefully move the foreskin. Pulling it or stretching the tip of penis vigorously can cause inflammation. Medical conditions: If anyone is suffering from diabetes, then there are chances of having a infection known as balanitis. This is typically an infection which takes place at the tip of the penis. Thus, in this case, it is necessary to discuss the problem with your doctor. Therefore, after going through your complete medical history, he can suggest you the best treatment which can manage the swelling of the penis.

 

Why Paraphimosis happens?

 

	Mishandled foreskin Piercing

 

Treatment and cure for Paraphimosis:
The manual reduction is the first treatment which is suggested by your doctor. In this procedure, analgesic is given as a pain killer through the mouth. Other than this local anesthetic block is applied to your penis. Or applying anesthetic jelly in a local area is quite helpful during manual reduction. Injections of hyaluronidase are also effective to decrease the swelling.

 

 

 

Management Of Constipation & Bleeding In Rectum In Children!

 

Constipation is a symptom, not a disease. Constipation is a digestive disorder system where an individual faces difficulty to expel. An incomplete bowel movement is a sign of constipation. This condition causes the stiffening of stool near the rectum, obstructing the smooth passage of stool. In most of the cases, this occurs because of the improper diet. If one is suffering from constipation the faeces become hard, dry and emptying the bowels become painful. Sometimes it causes bleeding in the rectum. Constipation may also cause the abdominal pain.

Constipation is very common in kids. Constipation is a temporary problem, but, chronic constipation may lead to serious problems. The common causes of constipation in kids are improper toilet training and diet less in fibre content. One can avoid this by eating healthy food rich in fibre, drinking more and more fluids.

 

Symptoms

Mention below are the symptoms of constipation:

 

	Regular stomach ache and less than three bowel movements a week. Bowel moment is slow and hard to pass. Emptying the bowel becomes painful. Blood on surface of hard stool. Abdominal pain

 

Causes

 

Toilet training: Improper toilet training is one of the major causes of constipation. One must follow a proper routine for passing out stool. Diet: If you are not providing a child a food rich in fibre than the child may suffer from constipation. Consuming a dairy product also leads to the same problem. Sodas and drinks containing caffeine cause dehydration and worsen constipation. Change in routine: Change in routine such as long travelling, too hot or cold weather and stress can affect bowel functioning. Hirschprungs’ disease: There is absence of ganglion cells in intestine leading to failure of movement of bowel leading to constipation. Rectal polyp, Colonic polyp, Anal fissure: Causes bleeding per rectum. Blood streaks on stool occur in Constipation and Anal fissure. Bleeding in drops after passing stool occurs in Polyps.

 

Preventions

 

One can get the better results if an individual combines all the approaches given below:

 

Toilet training: Child should be encouraged to go to toilet at a particular time daily. Provide the child with comfortable footstool so that could comfortably release a stool. Diet: The Proper diet chart should be maintained for children. A balanced diet rich in fibre should be served. Increase the daily water intake of your children. Avoid fast food and dairy product. Medicines: If your child is taking some medicines review it. It may be causing constipation. In case the medicine is causing constipation then go for doctor opinion. Regular exercise: Regular exercise is one of the best ways to avoid constipation. Ask your child to do regular exercise and play outdoor games. Regular exercise increases metabolism and make our immune system strong. Regular check-up: A regular visit to the doctor helps to diagnose the health problem. A Regular check-up is necessary for maintenance of healthy body and it avoids the risk of serious disease caused by constipation.

 

 

 

UTI

 

UTI stands for urinary tract infections. In children a urinary tract infection (UTI) is a very common condition caused by bacteria. Bacteria that enter the urethra are flushed out through urination. But, when bacteria aren’t excluded out of the urethra, they may grow in the urinary tract and cause infections. The Survey state that up to 8% of girls and 2% of boys will get a UTI at an early age. Sometimes the symptoms of UTI are hard to detect in kids so it is better to get your child treated, as it turn into serious kidney diseases. With a right treatment your child will feel better within few days.

 

Symptoms of a UTI include:

 

	Burning and pain during micturation. Urgent need to go, but having a few drops of urine. Fever and vomiting commonly occur during UTI. Foul smell and cloudy urine.

 

Causes

 

Bladder outlet obstruction like posterior urethral valve in males Vesico ureteric reflux (VUR) Uretero pelvic junction obstruction (UPJ Obstruction) Constipation: Being constipated makes difficult to empty your bladder, which means trapped bacteria which increases risk of UTI. So in order to reduce the UTI risk, avoid constipation Dehydration: Drinking water not only quenches your thirst, but it also avoids the risk of getting UTI. We should drink enough water so that we can flush out bacteria that can cause UTI. Drinking water also avoids the constipation problem. Holding urine: Holding urine for 6 hours make UTI more common as bacteria in the bladder has lots of time to grow and cause infection. So ask your child to pass urine after few hours.

 

Prevention

 

	Avoid tight fitting clothes, especially for girl children. Drink more and more liquids and eat fibre rich food. Change the diaper of young child frequently. Ask your child to go for urine immediately rather than holding. Don’t give bubble bath to the child as it is a major source of bacteria.

 

Investigations:

 

	USG (KUB) Urine routine examination and culture sensitivity MCU (Micturating Cysto Urethrogram) Urodynamic study DTPA Scan DMSA Scan

 

Treatments

The most common antibiotics used for treatment are:Amoxicillin and clavulanic acid, Sulfamethoxazole-trimethoprim, Ofloxacin, Cefixime etc
Sometimes hospitalization is necessary in younger than 6 months old, if:

 

	The Child has a high fever and not improving.