Appendicitis: Role of Radiological Imaging in the Diagnosis - Essay Example

Appendicitis Role of radiological imaging in the diagnosis of a child with abdominal pain Appendicitis Role of radiological imaging in the diagnosis of a child with abdominal pain Introduction In children, abdominal pain is a common situation. Many unscheduled paediatric visits and emergency visits are as a result of the abdominal pain.1 A child could show signs of acute pain episode or with recurrent chronic pain. Only a minimum percentage of children having abdominal pain will have the organic symptoms that necessitates the management intervention.2 This essay explores the manifestation of abdominal pain with specific emphasis on the function of radiology imaging test. It seeks to find out the potential causes of the abdominal pain. The essay will explore the common clinically significance causes of child’s abdominal pain. Discussion In children, one of the most common symptoms is abdominal pain. Many parents attest that their children would always complain of some tummy aches. In many cases, these episodes are known to be insignificant. Many children would have various thresholds of tolerating pain3. On the other hand, the parents would have a variation in their threshold of the appropriate time of bringing their child to the hospital. The paediatric and paediatricians rooms of emergency are always full of parents in need of attention from the doctors. In this case, the physician need to decide the patients who warranty for more work up with imaging and the type of patients who require the referral to the paediatric surgeon.4 The surgeons need to decide the types of patients that warranty the interventions of the surgeon and the patients who need medical observation or management. Even though the presentation in a child with abdominal pain may be common, all the individual children would give unique challenges to the involved physicians. The abdominal pain pathophysiology is complex. The abdominal organ stimuli together with the gastrointestinal tract, move through the sympathetic nerves towards the ganglia of the thorax and the spinal cord. The shown stimuli have been reported to be poorly localized. The pain coming from the visceral glands is equally poorly localized, and is always believed to be the midline that is linked with the secondary autonomic effects like vomiting, nausea and pallor. In many cases, the many pain location may characterize the organ that is affected. The Epigastric pain comes from duodenum, stomach, pancreas, biliary system, or liver. Periumblical pain, comes from the small intestine. The infraumblical pain, on the other hand comes from the rectum and colon, ovaries and uterus, kidneys and bladder. The ovarian and renal pain is always located laterally to the side that is affected. Whenever intense, the visceral pain could occasionally, be called the dermatomal distribution. Other stimuli given out from the diaphragm, peritoneum parietal, and abdominal wall function through the somatic nerves. The origin of pain out of the parietal structures is always well localized and in most cases dermatomal in terms of distribution. The pain stimuli may vary in its effect. Traction, stretching, tension, and rapid distention of the organic symptoms of pain. Shearing, crushing or rather the slow gradual distension has been reported to have minimum pain. Ischemia and inflammation may equal lead to pain. Some psychological stimuli such as those initiated by pain itself may cause stress. Such stress could cause pylorospasm air that can be swallowed with resulting distention of the gut and altered tone of the intestines, which may result into abdominal pain and hinder the symptoms that could be inciting. About twenty five percent of the children would call for medical attention due to abdominal pain before the hit age 15. Of these, about five percent may need hospitalization and few of them may require the surgical intervention.5 Over 10% of the children could go through the problem of abdominal pain. One stud in this field reported the existence of abdominal pain for the unscheduled offices of the paedritian and the emergency room visits.6 The study added that in the twenty two thousands children observed by the doctor, only one thousand of them displayed the symptoms of abdominal pain of below three days. About three percent of the patients were diagnosed with abdominal pain of more than three days.7 In children, the sixth most common diagnosis displaying acute abdominal pain involved the pharyngitis ( 16%) upper infection of the respiratory tract together with ottis (18%), gastroenteritis \910\\5, uncertain etiological pain (15%), acute febrile (8%), and viral syndrome (17%). These studies showed out that about ten patients were diagnosed with appendicitis and two had diagnoses that were surgical. Other studies in this field have showed the eventual diagnoses that are normally given to the children displayiong acute pain. In a study that included 588 paediatric enrolment due to the acute abdominal pain in a duration that was below one week, 57% of the patients is played the eventual diagnoses having acute abdominal pain which was considered being non-specific., thirty one percent of the patients had appendicitis and twelve percent of them showed other diagnoses.8 Another similar diagnoses conducted by a surgeon to 364 admitted patients having the acute pain, about thirty percent obtained a diagnoses that showed the non specific pain, sixty seven percent of the patients had the non surgical diagnoses, twenty eight percent of them displayed appendicitis, and a three percent number of patients received the other surgery. 9 Another similar study was conducted among three hundred admitted patients with ages below fifteen years old. These patients were presented to the emergency room due to the abdominal pain. The study reported that thirty percent of the patients had abdominal pain, 15% of them had gastroenteritis,, where as 10 of them displayed he symptoms of appendicitis. About eighty percent of the diagnosed children received the non surgical diagnoses. A recent series involving one thousand children admitted to a huge inner city of a paediatric room having acute pain reported the diagnosis as being abdominal pain in over forty eight percent of the patients.10 This series presented abdominal pain as the common diagnosis in the subjects. The series showed a six percentage of patients with appendicitis together. surgical diagnoses were reported as being uncommon. 11 The review of literature shows that abdominal pain is a symptom that is extremely common in many children. It also shows that a big percentage of the children having the abdominal pain do no display a condition of surgery. These children in many cases go without any special diagnoses. \in children appendicitis can only account for a small fraction of admitted cases. The other surgical conditions that show abdominal pain in children are not common. The clinicians who care for the children surfing from abdominal pain have challenges in finding out the category of the children who require more work up. The relevance of the good physical examination and history may not be overstated. The decision of whether to get laboratory examination or rather the type of diagnosis is depended on the initial evaluation that was given to the patient and could be a guide towards the subsequent investigation such as those of imaging.12 In this regards, clinicians are expected to address questions like whether such a child needs an imaging diagnosis, whether the child require imaging for excluding the diagnoses, the category of imaging that would provide the needed information to give direction to the clinician. In many cases, the symptoms and signs that accompany the abdominal pain do suggest the existence of either the treatable or the organic etiology for the given pain. The different symptoms could exist suggesting a specialized process of the disease. In a child having abdominal pain the clinical findings could suggest a requirement for further investigation. This would include the pain that would be periumbilical, fever, abnormal urinalysis, leukocytosis, palpable mass, and bloody stool. Choosing the modality of imaging in children with the abdominal pain may be depended on the details of a well performed physical examination and history together with the initial laboratory evaluations. The imaging selection methods could have some variations as a result of the institutional and the personal experience and preferences. Ultrasound, Radiology, and CT (computed tomography), are the key tools of imaging that are used to evaluate the child with abdominal pain. The radiography imaging tools have been reported as being readily available, inexpensive, and easily obtained. These tools are unfortunately insensitive and not specific especially regarding the aspects of diagnosing appendicitis. The dose of radiation experienced would be minimum but also disadvantaged. However, the radiographs are known as being appropriate tools of imaging especially whenever the gastrointestinal tract could be suspected. \more often than not the radiographs could verify the suspicions diagnoses of appendicitis through finding out the appendicolith. \the role of radiographs is to exclude the existence of other non surgical conditions such as the glower lobe constipation and pneumonia. The radiographs also acts as a way of helping the clinicians to find out the different surgical conditions that could mimic the appendicitis including the bowel perforation, bowel obstruction, and intussusceptions. In many cases sonography may be chosen as the first modality of imaging in children having abnominal pain. In other case, sonography may be used inappropriately since it is believed to have minimum test in a child. The basic merit of sonography lies on the fact that it may have no radiation of ionizing that would be involved in the process. Even though, the still mages could be obtained, the test may be done at a real time giving room for discourse on the sonographer, patient, parent, and even the radiologist. This could give room for the correlation of the findings of sonography if a physical examination was performed together with a direct scanning as per the information that would be given by the patient together with her parents. In other cases the test could be done in a portable way when a patient\s condition call for it. The key demerit of this method is that it is depended on the operator. This means that adequate knowledge, and training of the pathologist may be expected. patience, and the skill of scanning may be necessary for the test. Even though the whole abdomen is not scanned this test cannot give an appropriate evaluation in comparison to the CT.13 CONCLUSION The chronic and acute abdominal pain are the major symptoms in the children displaying medical evaluation. Many children having acute abdominal pain, and recurrent chronic abdominal pain may have no identifiable organic reason of pain even when exposed to high amount of work-up. One careful physical and historical examination may be useful; in directing the further workup in children with pain, especially through the selection of the type of patients who require imaging, and the type of imaging test to be used. Imaging has a big role in making the diagnoses for the patients having the organic pain etiology and through excluding the diagnoses in the patients having the symptoms of organic disease. The protocols of imaging are normally designed for addressing a specialized diagnosis. The attention that is provided to a specific patient will ensure an efficient utilization of the resources of radiology. An appropriate communication in between the radiologists and the clinical physician is useful in identifying the manner in which the selected studies could tailored to best satisfy the diagnoses. Bibliography Donell OB, Experience of acute abdominal pain in one children s hospital. In: O Donell B, ed. Abdominal Pain in Children, Blackwell Scientific, Oxford, London, 1985; pp 57-59. Reynolds SL, MD Jaffe SL, “Diagnosing abdominal pain in a paediatric emergency department.” Pediatr Emerg Care 1992; 8:126-8. ones PF. The acute abdomen in infancy and childhood. Practioner 1979; 222:473-8. 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