16. Primary peritonitis. May occur in normal children (especially girls 2-6 years of age) but is more common in patients with nephrotic syndrome or cirrhosis, or after splenectomy. Bacterial infection; probably hematogenous source.
17. Other systemic illnesses. Abdominal pain may accompany other acute and chronic conditions (eg, lower lobe pneumonia, hepatitis, Henoch-Schonlein purpura, hemolytic uremic syndrome, sickle cell disease, porphyria, diabetes).
18. Recurrent abdominal pain (RAP). Occurs in 10% of children. Most cases are functional (ie, no structural or biochemical basis is found); 5-10% have one of the causes listed above. Emotional stress may contribute. Abdominal pain is more likely to be functional if it is intermittent, centrally located, not associated with meals, vomiting, a change in bowel habits, or jaundice; if it does not awaken patient from sleep; if patient is not ill; and if growth and development are normal.
a. Possible mechanisms. Increased gastric acid, intestinal hyperactivity, spasm of abdominal wall muscles.
b. Irritable bowel syndrome. This form of RAP occurs in older children and adolescents and is characterized by pain with diarrhea or constipation. Pain is often relieved by defecation.
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