Differential Diagnostic Criteria for Conditions Accompanied by Abdominal Pain Syndrome in Children

The research is dedicated to the development of differential diagnostic criteria for conditions accompanied by abdominal pain syndrome in children. The relevance of the work is due to the high frequency of pseudoabdominal syndrome in emergency pediatric surgery and the difficulties of its differentiation from a true acute surgical condition. The mechanisms of development of abdominal syndrome, the morphofunctional features of motor-evacuate function of the gastrointestinal tract in healthy children and patients, as well as an algorithm for differential diagnosis using computer phonoenterography and pharmacological ganglioplegia with pentamine were studied in the work.

RELEVANCE OF THE SCIENTIFIC RESEARCH

Abdominal pain syndrome is a leading feature in the clinical presentation of a number of diseases of pediatric age. The diversity of clinical manifestations and atypical variants of the course of various diseases often cause significant difficulties in the differential diagnosis of abdominal syndrome in children.

One of the complex problems of medicine remains pseudoabdominal syndrome (the so-called false "acute abdomen"), the proportion of which, according to data from various authors, ranges from 5 to 25% in emergency diagnosis (Rozhal L.M., 1996; Yudin Ya.B., 1998). For many physicians, this is one of the most difficult sections of differential diagnosis, since the clinical picture simulating an acute surgical disease of the abdominal organs may develop in pathology of the thoracic organs, retroperitoneal space, nervous system, in non-surgical diseases of the abdominal organs, functional changes, and many other conditions that, unlike the true "acute" abdomen, do not require emergency surgical treatment.

By the leading mechanism of pain occurrence in the abdominal cavity, they are divided into visceral and somatic. Visceral pain arises in the presence of pathological impulses in the internal organs and is conducted by sympathetic fibers. The main impulses for its occurrence are a sudden increase in pressure in a hollow organ and stretching of its wall, tension of the mesentery, and vascular disturbances. Somatic pain is caused by the presence of pathological processes in the parietal peritoneum and tissues possessing endings of sensory nerves and is conducted by spinal nerves to the brain. The main impulses for its occurrence are damage to the abdominal wall and peritoneum.

In the development of abdominal syndrome, motor-evacuate disorders of various sections of the digestive tract play a certain role, the diagnosis of which is based on modern non-invasive methods of investigation, such as computer phonoenterography. However, works of this kind are insufficient.

Experimental and clinical investigations have shown that the use of ganglioblockers can achieve blockade of pathological viscero-visceral and viscero-somatic reflexs (R.M. Evtikhov, 1986). The value of blockade of vegetative ganglia as a method of prevention and elimination of pathological impulses from the focus of damage is associated with the fact that afferent and efferent pathways to the internal organs pass through vegetative ganglia, on which ganglioblockers exert a selective action, and it is especially important that they do not exert a depressing influence on the central nervous system, are non-toxic, and do not block transmission of excitation in other links of the reflex arc. However, in pediatric practice, these methods have not yet found proper application.

To date, in the examination of a patient, such clinical methods as palpation, by means of which the presence or absence of muscular tension in the patient can be identified, have significance. In this case, the clinical experience of the physician is of decisive importance. Objectification of the determination of the state of muscle tone is made possible by the use of computer electromyography, combined in a number of cases with pharmacological ganglioplegia. This will lead to a reduction in the number of unjustified laparoscopic investigations (A.F. Dronov, 2000; V.I. Kotlobovsky, 2002).

The goal of the scientific research: to identify the features of motor-evacuate function of the digestive tract in healthy children and in conditions accompanied by various variants of abdominal syndrome, by means of evaluation of changes in phonoenterography indicators in combination with ganglioplegia, in order to propose objective criteria and an algorithm for their differential diagnosis.

The tasks of the scientific research:

1. To establish the structure of diseases accompanied by abdominal pain syndrome and the clinico-functional features of variants of their course.

2. To provide a comparative characterization of motor-evacuate function of the digestive tract in healthy children and patients with abdominal syndrome according to computer phonoenterography.

3. To develop and test a method of pharmacological ganglioplegia with pentamine for differential diagnosis of abdominal syndrome in somatic and acute surgical diseases of the abdominal organs in children.

4. To evaluate the effectiveness of the use of traditional methods and the method of pharmacological ganglioplegia with pentamine in combination with computer phonoenterography and electromyography for differential diagnosis of abdominal syndrome in diseases of the abdominal organs in children.

5. To develop an algorithm for differential diagnosis of various clinico-anamnestic variants of abdominal pain syndrome in children.

SCIENTIFIC NOVELTY OF THE RESEARCH

- The clinico-anamnestic variants of the course of abdominal pain syndrome in children of school age were clarified, taking into account the localization, character, duration, and dynamics of pain, the frequency of vomiting, and the presence of muscular tension.

- Criteria for quantitative and qualitative assessment of motor-evacuate function of the intestine according to computer phonoenterography were developed, with the allocation of types of peristalsis in healthy and sick children of school age.

- For the first time, a method of pharmacological ganglioplegia with pentamine for the elimination of pseudoabdominal syndrome in children was developed, using the assessment of motor-evacuate function of the gastrointestinal tract according to computer phonoenterography.

- Differential diagnostic criteria of abdominal pain syndrome were identified for the choice of an invasive or non-invasive treatment strategy for patients.

- An algorithm for differential diagnosis of diseases accompanied by abdominal pain was proposed, including the establishment of the clinical variant of abdominal syndrome, assessment of leukogram indicators, motor-evacuate function of the intestine according to computer phonoenterography, electromyography indicators, and ganglioplegia.

PRACTICAL SIGNIFICANCE OF THE RESEARCH

A method of differential diagnosis of abdominal pain syndrome based on the use of ganglioplegia with pentamine and computer phonoenterography was tested, which makes it possible to increase the effectiveness of the diagnostic procedure by reducing its duration, the number of diagnostic errors, and the number of unjustified laparoscopies and laparotomies in children.

It has been shown that ganglioplegia with pentamine and computer phonoenterography are non-invasive methods of differential diagnosis of abdominal syndrome compared to laparoscopy.