1. ATAN BAAS SINUHAJI Sub Division of Pediatrics Gastroentero-Hepatology Department of Child Health, School of Medicine University of Sumatera Utara/ Adam Malik Hospital MEDAN 1 ABDOMINAL PAIN

2. CLASSIFICATION OF ABDOMINAL PAIN 1.ORGANIC/ANORGANIC 2.ACUTE/CHRONIC (RECURRENT ABD. PAIN : 1X/MONTH 3 MONTHS) 3. CONTINUE/INTERMITTENT 4. SPASMODIC/NON SPASMODIC 5.SOURCE 6. AFFERENT FIBERS 7. SURGERY/MEDICAL

3. RECURRENT ABDOMINAL PAIN ORGANICFUNCTIONAL IDIOPATHIC IRRITABLE BOWEL SYNDROME ( IBS )

4. IRRITABLE BOWEL SYNDROME FUNCTIONAL GASTROINTESTINAL DISOERDER Chronic/recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities

5.  VOMITING AND AEROPHAGIA  ABDOMINAL PAIN  CONSTIPATION AND INCONTINENCE 1.Adolescent rumination syndrome 2. Cyclic vomiting syndrome 3. Aerophagia 1.Functional dyspepsia 2. IBS 3.Abdominal migrain 4.Childhood functional abdominal pain 1.Functional constipation 2.Nonretentive fecal incontinence FUNCTIONAL GI DISOERDERS

6. DIAGNOSTIC CRITERIA* FOR IBS ( ROME III ) Must include all of the following : 1.Abdominal discomfort ( an uncomfortable sensation not described as pain ) or pain associarted with 2 or more of the following at least 25 % of the time : a. Improved with defecation b. Onset associated with a change in frequency of stool c. Onset associated with a change in form ( appearance ) of stool 2. No evidence of an inflammatory,anatomic,matabolic or neoplastic process that explains the subject’s symptoms * Criteria fulfilled at least once per week for at least 2 months before diagnosis

7. SOURCE OUT OF ABDOMINAL ABDOMINAL REFERRED PAIN (eg. PLEURITIS) PARIETAL VISCERAL VISCERAL PERIT.. VISCERAL ORGAN NB.STIMULATION WITH COUNTERIRRITANTS AT THE SKIN OVER AN THE AREA OF VISCERAL INFLAMMATION PRODUCES SOME RELIEF OF PAIN  SOURCE IS NOT CLEAR SKIN MUSCLE PARIETAL PERIT.

8. CAUSES OF VISCERAL ABD. PAIN 1.INFLAMMATION 2.OBSTRUCTION 3.METABOLIC 4.BLEEDING 5.CONGESTION 6.DYSMOTILITY 7.ULCER

9. OBSTRUCTION HOLLOW ORGAN 1.GASTROINTEST. TRACT 2.GENITOURINARY TRACT 3.BILIARY TRACT 4. PANCREAS

10. AFFERENT FIBERS A FIBERS C FIBERS PARIETAL VISCERAL --SLOW/DIFFUSE --POORLY LOCALIZED --MID-LINE --MOVEMENT --COLIC NB. IF APPENDICITIS CHILD HAS BRIGHT SHARP LOCALIZED PAIN INVOLVED PARIETAL PERIT. IMPENDING PERFORATION

11. NERVE FIBERS A CB - SENSORIC & MOTORIC - DIAMETER LARGE - CONDUCTIVE FAST - PREGANGLIONIC AUTONOMIC - DIAMETER MODERATE - CONDUCTIVE MODERATE - SENSORIC & POST GANGL. SYMPHATETIC - DIAMETER SMALL - CONDUCTIVE SLOW

12. COLIC < 3 MONTHS ADULTS SPASM CRYING  3 HOURS/DAY  3 DAYS/WEEK  3 WEEKS WESSEL’S RULE OF THREE INFANTILE

13. SURGERY ELECTIVE POLYPS PEUTZ JEGHERS SYNDR. ACUTE ABDOMEN INVAGINATION PERFORATION VOLVULUS MEDICAL DIGESTIVE TRACT OUT OF DIGESTIVE TRACT GE ULCER ASCARIASIS CONSTIPATION - URINARY TRACT INFECTION -SALPHINGITIS -PNEUMONIA - SPINAL NERVE COMPRESSION

14. PEUTZ JEGHERS SYNDROME DOMINANTLY INHERITED ABDOMINAL PAIN MUCOCUTANEUS JUNCTION PIGMENTATION POLYPS OF GI TRACT

15. ABDOMINAL PAIN ACUTECHRONIC NOT LOOKING WELL WELL ACUTE ABDOMEN MEDICAL -FUNCTIONAL - ELECTIVE SURGERY

16. ATAN BAAS SINUHAJI Sub Division of Pediatrics Gastroentero-Hepatology Department of Child Health, School of Medicine University of Sumatera Utara / Adam Malik Hospital MEDAN 16 DISORDERS OF INGESTION

17. Disorders of ingestion Poor SuckingPainful swallowing Difficulty swallowing = Dysphagia = odinophagia stomatitis

18. Dysphagia Motility disorders = function structural Dysmotility Oroph Esoph AnatomicalObstruction Schizis Pierre Robin syndr. ExtInt. Stenosis Webs Stricture Tumor

19. COMPLICATION Recurrent Resp. Tr. Infection PCM

20. Stomatis VITAMIN  VIRALCANDIDA ALBICANS ANGINA PLAUT VINCENT Herpes Herpangina Thrush a - Moniliasis

21. MONILIASIS WHITE PLAQUE INFLAMMATION Bottle feeding Steroids Antibiotics Th Gentian violet 1% Nystatin  Nymiko ®

22. PIERRE ROBIN SYNDROME = MICROGNATHIA = HIGH ARCHED / CLEFT PALATE = PSEUDOMACROGLOSIA = FLOOR OF THE MOUTH IS FORESHORTENED MAINTAIN IN A PRONE POSITION

24. ESOPHAGEAL STRICTURE CAUSTIC AGENT ACID ALKALI Bitter Less be consumed Coagulum Necrosis Stomach Neutral More be consumed Liquefaction necrosis Deep Penetration

25. Th Caustic ingestion A. ACUTE1. Vomiting shouln’t be induced 2. Neutralizing agent shouldn’t be given 3. Nasogastric tube shouldn’t be inserted 4. Clean water 5. Corticosteroid  stricture ?? B. CHRONIC / COMPLICATION  stricture  dilatation