Çocuklarda Karın Ağrısı
Özet
Çocuklarda karın ağrısı, pediatrik acil servis ve poliklinik başvurularının en sık nedenlerinden biri olup geniş bir etiyolojiye sahiptir. Etiyoloji yaşa bağlı olarak değişmekte ve fonksiyonel gastrointestinal bozukluklar, enfeksiyöz hastalıklar ve konstipasyon gibi benign nedenlerden, apandisit, invajinasyon ve volvulus gibi hayatı tehdit eden cerrahi patolojilere kadar uzanmaktadır. Klinik değerlendirmede ayrıntılı anamnez alınması, ağrının başlangıcı, lokalizasyonu, süresi ve eşlik eden semptomların sorgulanması önemlidir. Fizik muayenede vital bulgular, abdominal hassasiyet, defans ve geri tepme duyarlılığı varlığı dikkatle değerlendirilmelidir. Gece uyandıran ağrı, kilo kaybı, büyüme geriliği, kanlı dışkı ve safra içerikli kusma gibi alarm bulguları organik patolojiler açısından uyarıcıdır. Tanısal yaklaşımda laboratuvar testleri klinik şüpheye göre seçilirken, ultrasonografi radyasyon içermemesi ve yüksek tanısal değeri nedeniyle ilk tercih edilen görüntüleme yöntemidir. Apandisit, çocukluk çağında en sık cerrahi karın ağrısı nedeni olup, invajinasyon ve volvulus erken tanı ve acil müdahale gerektiren durumlardır. Çocuklarda karın ağrısına yaşa özgü, sistematik ve algoritmik bir yaklaşım; doğru tanı, uygun tedavi ve zamanında cerrahi konsültasyon açısından kritik öneme sahiptir. Erken tanı ve uygun yönetim morbidite ve mortaliteyi anlamlı şekilde azaltmaktadır.
Abdominal pain in children is one of the most common reasons for visits to pediatric emergency departments and outpatient clinics and has a wide etiological spectrum. The etiology varies according to age and ranges from benign causes such as functional gastrointestinal disorders, infectious diseases, and constipation to life-threatening surgical conditions such as appendicitis, intussusception, and volvulus. In clinical evaluation, obtaining a detailed medical history is essential, including the onset, location, duration of pain, and associated symptoms. During physical examination, vital signs, abdominal tenderness, and the presence of guarding and rebound tenderness should be carefully assessed. Alarm symptoms such as pain that awakens the child from sleep, weight loss, growth retardation, bloody stools, and bilious vomiting are warning signs for organic pathology.In the diagnostic approach, laboratory tests are selected based on clinical suspicion, while ultrasonography is the first-line imaging modality due to its lack of radiation and high diagnostic value. Appendicitis is the most common surgical cause of abdominal pain in childhood, and intussusception and volvulus are conditions requiring early diagnosis and urgent intervention. A systematic and algorithmic, age-specific approach to abdominal pain in children is critical for accurate diagnosis, appropriate treatment, and timely surgical consultation. Early diagnosis and appropriate management significantly reduce morbidity and mortality.
Referanslar
Tintinalli JE, Ma OJ, Yealy DM, et al. (eds.). Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill Education; 2020. p. 857–864.
Kliegman RM, St Geme JW, Blum NJ, et al. (eds.). Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2020. p. 3127–3132.
Walls RM, Hockberger RS, Gausche-Hill M, et al. (eds.). Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia: Elsevier; 2023. p. 2126–2144.
Korterink JJ, Diederen K, Benninga MA, et al. Functional abdominal pain in children. Pediatrics. 2016;138(1):e20161512. doi:10.1542/peds.2016-1512
Fallon SC, Kim ES, Naik-Mathuria BJ, et al. Pediatric acute abdominal pain. Journal of Pediatric Surgery. 2018;53(10):1911–1916. doi:10.1016/j.jpedsurg.2018.02.086
Di Lorenzo C, Colletti RB, Lehmann HP, et al. Chronic abdominal pain in children: Mechanisms and management. Journal of Pediatric Gastroenterology and Nutrition. 2018;66(1):1–10. doi:10.1097/MPG.0000000000001706
Saps M, Di Lorenzo C, Benninga MA, et al. Functional gastrointestinal disorders in children. Gastroenterology. 2016;150(6):1456–1468. doi:10.1053/j.gastro.2016.02.015
Korterink JJ, Rutten JMTM, Venmans L, et al. Alarm symptoms in pediatric abdominal pain. Archives of Disease in Childhood. 2017;102(2):128–132. doi:10.1136/archdischild-2016-311503
Trout AT, Towbin AJ, Fierke SR, et al. Imaging of abdominal pain in children. Radiographics. 2020;40(7):1843–1863. doi:10.1148/rg.2020200027
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. The Lancet. 2017;390(10104):102–110. doi:10.1016/S0140-6736(17)30360-0
Bhatt M, Joseph L, Ducharme FM, et al. Acute appendicitis in children. JAMA Pediatrics. 2017;171(5):426–433. doi:10.1001/jamapediatrics.2017.0041
Navarro O, Daneman A. Intussusception in children: Diagnosis and management. Radiologic Clinics of North America. 2017;55(4):773–789. doi:10.1016/j.rcl.2017.02.007
Nehra D, Goldstein AM. Intestinal malrotation and volvulus. Journal of Pediatric Surgery. 2019;54(7):1361–1369. doi:10.1016/j.jpedsurg.2018.10.042
Neu J, Walker WA. Necrotizing enterocolitis. New England Journal of Medicine. 2017;377(19):1904–1915. doi:10.1056/NEJMra1603837
Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of pediatric inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition. 2018;67(2):257–291. doi:10.1097/MPG.0000000000002036
Referanslar
Tintinalli JE, Ma OJ, Yealy DM, et al. (eds.). Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York: McGraw-Hill Education; 2020. p. 857–864.
Kliegman RM, St Geme JW, Blum NJ, et al. (eds.). Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2020. p. 3127–3132.
Walls RM, Hockberger RS, Gausche-Hill M, et al. (eds.). Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia: Elsevier; 2023. p. 2126–2144.
Korterink JJ, Diederen K, Benninga MA, et al. Functional abdominal pain in children. Pediatrics. 2016;138(1):e20161512. doi:10.1542/peds.2016-1512
Fallon SC, Kim ES, Naik-Mathuria BJ, et al. Pediatric acute abdominal pain. Journal of Pediatric Surgery. 2018;53(10):1911–1916. doi:10.1016/j.jpedsurg.2018.02.086
Di Lorenzo C, Colletti RB, Lehmann HP, et al. Chronic abdominal pain in children: Mechanisms and management. Journal of Pediatric Gastroenterology and Nutrition. 2018;66(1):1–10. doi:10.1097/MPG.0000000000001706
Saps M, Di Lorenzo C, Benninga MA, et al. Functional gastrointestinal disorders in children. Gastroenterology. 2016;150(6):1456–1468. doi:10.1053/j.gastro.2016.02.015
Korterink JJ, Rutten JMTM, Venmans L, et al. Alarm symptoms in pediatric abdominal pain. Archives of Disease in Childhood. 2017;102(2):128–132. doi:10.1136/archdischild-2016-311503
Trout AT, Towbin AJ, Fierke SR, et al. Imaging of abdominal pain in children. Radiographics. 2020;40(7):1843–1863. doi:10.1148/rg.2020200027
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. The Lancet. 2017;390(10104):102–110. doi:10.1016/S0140-6736(17)30360-0
Bhatt M, Joseph L, Ducharme FM, et al. Acute appendicitis in children. JAMA Pediatrics. 2017;171(5):426–433. doi:10.1001/jamapediatrics.2017.0041
Navarro O, Daneman A. Intussusception in children: Diagnosis and management. Radiologic Clinics of North America. 2017;55(4):773–789. doi:10.1016/j.rcl.2017.02.007
Nehra D, Goldstein AM. Intestinal malrotation and volvulus. Journal of Pediatric Surgery. 2019;54(7):1361–1369. doi:10.1016/j.jpedsurg.2018.10.042
Neu J, Walker WA. Necrotizing enterocolitis. New England Journal of Medicine. 2017;377(19):1904–1915. doi:10.1056/NEJMra1603837
Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of pediatric inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition. 2018;67(2):257–291. doi:10.1097/MPG.0000000000002036
