臨牀消化器内科 Vol.20 No.6(6-6)


特集名 小児の腹痛とその処置 -- 最新の捉え方
題名 腹痛をきたす小児の重要疾患 -- その診断と治療 (6) 腸管以外の注意すべき疾患 (性器疾患，腎泌尿器疾患など)
発刊年月 2005年 06月
著者 池谷 健 藤枝市立総合病院小児科
【 要旨 】 小児科医にとっても腹痛は手ごわい訴えである．小児はしばしば腹痛を訴えるうえに，腸重積に代表されるような緊急処置を必要とする疾患が含まれているからである．
診療の現場で腹痛を訴える小児に出会ったとき，消化管内の疾患から考察していくのは当然であるが，消化管外の原因からくる腹痛も念頭において診療に当たることが大切である．
ここでは非腸管性の腹痛のうち，緊急に対処する必要がある疾患，応急処置後に専門医に紹介する必要がある疾患，それ以外のよく出会う疾患，について述べた．急性腹痛や慢性腹痛の急性増悪では，専門医への紹介までに行う応急処置を中心に，慢性腹痛では多彩な疾患の概念を中心に述べた．
Theme Abdominal Pain in Children : Current Clinical Management
Title Extra-intestinal Disorders : Urogenital Diseases and Other Disorders
Author Takeshi Ikegaya Department of Pediatrics, Fujieda Municipal Hospital
[ Summary ] Abdominal pain is a common symptom in the children. Some children need emergency treatment, such as intussusception. To diagnose the origin of their illness, first we consider whether their overall symptoms are consistent with specific gastro-intestinal disease. However if they are not, we must next consider urogenital disorders, and then other extra-intestinal disorders.
Non-urogenital extra-intestinal disorders, which can cause abdominal pain in children, include infectious disease especially of the respiratory tract, cardiovascular diseases, metabolic disorders, and collagen diseases. Young patients, who are suffering from acute infectious disease, i. e. pharyngitis, tonsillitis, bronchitis, pneumonia, or bronchial asthma, often complain of abdominal pain.
Among the possible disorders, the following seven disorders must be emphasized due to their urgency acute adrenal insufficiency, hyperglysemia due to diabetes or hypoglysemia, theophyllin intoxication, ovarian torsion, intravaginal torsion of testis, myocardial infarction due to Kawasaki disease, and child abuse.
In this article, preliminary examinations and first aid are described in relation to the seven disorders and urogenital or other important disease. The diagnosis of disorders with abdominal pain which we frequently encounter in the hospital, is also described.
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