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Children's Health

Abdominal pain in children

12/19/2006

Question:

my child has had upper right quad abdominal tenderness with some nausea and has vomited 2-3 times she says that after she vomits her stomach feels better there is no swelling of the stomach but she has alot of gas and burps alot with a bad odor her stool has been formed with a green color this has been happening for approx. 5 days her appetite has improved in the last day but she says she is still sore in her stomach

Answer:

One of the most common causes of right upper quadrant pain in the abdomen is cholecystitis or inflammation of the gallbladder. It occurs in less than 1% to 4% of children and is twice as likely to affect white children as black children. In children before their teens, it affects girls and boys equally, but in the teens, girls are affected more often than boys. 

The symptoms are right, upper quadrant abdominal pain (79%), pain over the stomach (19%), radiation of the pain to the back and shoulder (38%), vomiting (41%), and dietary fat intolerance (resulting in gas and stool changes, 33%). Some children may also have fever, jaundice or yellow tint to the skin, or feel a mass in the upper right abdomen.  

Appendicitis is the most common disease confused with acute inflammation of the gall bladder or cholecystitis. Hepatitis, kidney inflammation, reflux disease and pneumonia may all present with pain in the right upper quadrant. So the best course of action is to take your daughter to see her doctor as soon as possible for a good history and physical exam, because all of these problems need prompt medical care. 

If it is gall bladder inflammation, it is diagnosed best by abdominal ultrasound, which is completely safe and painless. Her doctor may also want blood tests. The treatment is bowel rest, IV fluids and antibiotics for 3-7 days and then gall bladder removal using laparoscopy, which leaves 3 small scars and usually has a quick recovery time.

I hope all goes well with a quick diagnosis and effective treatment for the problem that will allow all of your family to enjoy happy holidays.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University