Abdominal distension in children

　　1. Etiology

　　The main sources of gas in the normal intestine are the gas inhaled from the throat and the gas produced in the digestive tract (especially the gas produced by bacterial fermentation), and the sources of liquid in the intestine include saliva, gastric juice, bile, pancreatic juice, and small intestinal fluid. These liquids and gases can be reabsorbed or partially excreted through the normal digestive process in healthy individuals.

　　There are mainly 3 situations for the accumulation of gas and fluid in the intestines: mechanical intestinal obstruction, functional intestinal dilatation (paralytic intestinal obstruction), and ascites. The causes of abdominal distension can be roughly divided into the following 6 types:

　　1. Gastrointestinal diseases

　　(1) Gastric diseases: Commonly found in chronic gastritis, gastric ulcer, gastric prolapse, gastric dilation, and pyloric obstruction, etc.

　　(2) Intestinal diseases: Commonly found in intestinal tuberculosis, dysentery, intestinal obstruction, and habitual constipation, etc.

　　(3) Others: Gastrointestinal neurosis.

　　2. Liver, gallbladder, and pancreas diseases

　　Such as acute and chronic hepatitis, liver cirrhosis, chronic cholecystitis, cholelithiasis, and pancreatitis, etc.

　　3. Peritoneal diseases

　　Common in acute peritonitis, tuberculous peritonitis, etc.

　　4. Cardiovascular diseases

　　Common in heart failure, mesenteric arteriosclerosis, mesenteric artery infarction, etc. Angina pectoris and arrhythmias can also cause abdominal distension reflexively.

　　5. Acute infectious diseases

　　Such as sepsis, severe pneumonia, typhoid fever, etc.

　　6. Others

　　It can be seen in postoperative intestinal paralysis, emphysema, asthma, hypokalemia, malabsorption syndrome, spinal cord lesions, drug reactions, chronic pelvic inflammatory disease, adnexitis, connective tissue diseases, and hypothyroidism, etc.

　　2. Pathogenesis

　　1. Mechanical intestinal obstruction

　　The reabsorption and excretion of gas and fluid in the proximal intestine are impaired. The bacteria in the intestine produce a large amount of gas due to changes in the intestinal environment, resulting in abdominal distension. B-ultrasound, barium enema, upright X-ray photograph, or fluoroscopy can show multiple liquid levels and contracted colon in the small intestine, which can be diagnosed.

　　2. Functional intestinal bloating

　　The main cause is the dysfunction of the enteric autonomic nervous system, leading to dysmotility of the gastrointestinal tract, such as systemic severe infection, sepsis, pneumonia, encephalitis, toxicosis, or toxic shock, which causes microcirculatory disorders. The gastrointestinal tract is first ischemic and hypoxic, leading to weak expansion and abdominal distension. Intestinal paralysis after peritonitis and abdominal injury (including surgical injury) can also cause abdominal distension. Gas absorption disorders can also cause abdominal distension. Especially colonic distension is more common, and B-ultrasound and barium enema can show colonic inflation and expansion.

　　3. Peritoneal effusion

　　Abdominal distension caused by ascites is often due to low plasma protein, liver cirrhosis, congestive heart failure, portal hypertension, peritoneal inflammation, or tumor. The signs are different from those of gas distension. Ultrasound examination and X-ray fluoroscopy show the intestines floating in ascites.

　　The symptoms may vary depending on the underlying cause. Nausea, vomiting, increased bowel sounds, constipation, and others may occur concurrently. Increased bowel sounds: When intestinal peristalsis is enhanced, the frequency of bowel sounds increases, and the sounds are loud and high-pitched, even like jingling or metallic sounds, which is called increased bowel sounds and is seen in mechanical intestinal obstruction. In such patients, the intestinal lumen expands, the intestinal wall swells and becomes thin, and it is extremely tense, which can resonate with the increased bowel sounds, so a high-pitched metallic tone can be heard in the abdomen. During physical examination, the right lower quadrant is usually used as the listening point for bowel sounds. Normally, bowel sounds are about 4-5 times per minute, with great variation in frequency, loudness, and pitch. They are frequent and pronounced after meals and sparse and weak during rest, and only the examiner's experience can judge whether they are normal.

　　1. Clinical manifestations

　　Children often have an acute or chronic illness, with the abdomen bulging and higher than the chest. Severe abdominal distension can affect breathing and cause difficulty in lying flat.

　　There are two types of gas swelling, usually gastrointestinal gas, but a few cases are abdominal gases. In these cases, besides the subdiaphragmatic air accumulation checked by standing X-ray, the clinical examination of the abdomen can feel that the abdominal cavity is relatively empty and soft, while the intestinal gas can be felt as the shape of the intestines.

　　Second, Related Examinations

　　1. Abdominal Examination

　　Lightly tap the abdomen, tympany indicates gas, dullness indicates a solid mass, and dullness with conductive tremor indicates fluid collection. Abdominal auscultation shows hyperactive bowel sounds in mechanical intestinal obstruction, while in paralytic intestinal obstruction, bowel sounds are weakened or disappear.

　　2. Clinical Physical Examination

　　Clinical physical examination is very important for abdominal distension in children. Through careful and detailed clinical physical examination, a general diagnosis of the disease can often be made, or a path for further auxiliary examination can be found. Otherwise, there may be missed or misdiagnosis, causing damage to the child or even endangering life.

　　1. Reducing the Intake of Foods That Produce Gas in the Gastrointestinal Tract

　　Such as potatoes, starchy foods, sugar, etc., are easy to produce gas in the gastrointestinal tract, leading to abdominal distension in the end.

　　2. Avoiding Indigestible Foods

　　Sticky foods such as fried beans and hard cakes are not easy to digest, stay in the gastrointestinal tract for a long time, and may produce more gas, causing abdominal distension.

　　3. Good Eating Habits

　　Change the habit of eating quickly, as eating too fast or eating while walking is easy to swallow a lot of air; drinking beverages with a straw will also allow a large amount of air to seep into the stomach, causing abdominal distension.

　　4. Preventing Negative Emotions

　　Anxiety, worry, sadness, depression, and other negative emotions may weaken digestive function or stimulate the stomach to produce too much stomach acid.

　　5. Strengthening Physical Fitness

　　Pay attention to physical exercise, persist in moderate outdoor activities every day, which not only helps to overcome negative emotions but also helps the digestive system maintain normal function.

　　6. Moderate Intake of Fiber-rich Foods

　　High-fiber foods sometimes have the effect of reducing abdominal distension, especially after consuming high-fat foods. This is because high-fat foods are difficult to digest and absorb, and therefore often stay in the gastrointestinal tract for a longer time. Once fiber is added, the blocked digestive system is likely to be quickly unblocked.

　　7. Prevention of Gastrointestinal Diseases

　　For some diseases, abdominal distension may be a prodromal symptom or one of the symptoms, such as allergic colitis, ulcerative colitis, etc.

　　First, Blood Routine

　　Abdominal distension caused by various infections can be seen in infectious blood pictures, rapid blood sedimentation, positive blood culture, and increased acute phase proteins. B-ultrasound, barium enema, erect X-ray film or fluoroscopy can be performed. Multiple liquid levels and atrophied colon in the small intestine can be diagnosed as mechanical intestinal obstruction; colonic distension can be seen in paralytic intestinal obstruction; floating intestines in ascites indicate the characteristics of ascites.

　　Second, Routine Radiology Examination

　　1. Abdominal Plain Film

　　Abdominal plain films should be the first choice for diagnosing pneumoperitoneum. In addition to suggesting different locations of intestinal obstruction, it may also suggest the size and location of abdominal space-occupying lesions. Abdominal plain films are also easy to show calcification and skeletal shadows of teratomas with different characteristics of meconium peritonitis and neuroblastoma, thus suggesting diagnosis.

　　2. Gastrointestinal Contrast Imaging

　　(1) Barium meal:

　　Barium meal is used to determine the size and location of abdominal space-occupying lesions.

　　(2) Barium enema:

　　For children with intestinal obstruction, barium enema can be used to observe whether there is gas in the colon to determine whether the obstruction is complete. Pelvic masses and rectal lesions may also be diagnosed by barium enema.

　　3. Urological Contrast Imaging

　　(1) Intra-venous pyelography (IVP):

　　It is often used to diagnose congenital malformations or tumors of the urinary system, such as the diagnosis of renal pelvis积水 and Wilms' tumor.

　　(2) Retrograde cystography:

　　It is of great significance for the diagnosis of urethral valves, renal pelvis cysts, and bladder tumors.

　　Three, CT examination

　　This examination can not only measure the size of the mass but also determine whether the mass is solid or cystic, determine the thickness of the cyst wall, and get a general idea of the nature of the contents. CT examination can also often suggest the origin of the mass from a particular organ or show its relationship with surrounding organs.

　　Four, Ultrasound

　　Color Doppler can display the blood supply of organs and the morphology of the vascular system, and can also indicate the direction and speed of blood flow, which has unique advantages compared to CT.

　　One, dietary therapy for children with bloating

　　1. Radish and sour plum decoction

　　Take about 250 grams of fresh radish, cut into thin slices; two sour plums. Boil with three bowls of water to make one and a half bowls, remove the residue and take the juice, add a little salt for seasoning and drink. It has the effects of relaxing the middle jiao, promoting the flow of qi, resolving accumulation, promoting the production of saliva, and clearing heat and phlegm. It is suitable for symptoms such as chest tightness, heartburn, bloating,胁痛, irritability, and reversed qi caused by food accumulation or overeating.

　　2. Treat bloating and loss of appetite

　　Take 100 grams of winter melon peel and boil with one carp, cook until soft and eat. Take once every other day, for 3 to 5 times in total.

　　3. Quail porridge

　　Take one quail, remove the feathers and intestinal contents, cut into small pieces, 100 grams of rice, cook together into porridge, season with a moderate amount of oil and salt for eating. It has the effects of invigorating the spleen and stomach, nourishing the Qi and blood, and eliminating dampness and accumulation. It can treat symptoms such as malnutrition, abdominal distension, loss of appetite, spleen deficiency with loose stools, and weakness of the body. It can be eaten as breakfast and dinner, once a day or every other day.

　　Two, what foods are good for children with bloating

　　1. Moderately supplement high-fiber foods High-fiber foods are not only likely to cause 'bloating', but sometimes they can actually alleviate 'bloating', especially after consuming high-fat foods. This is because high-fat foods are difficult to digest and absorb, and they often stay in the gastrointestinal tract for a longer time. Once fiber is added, the blocked digestive system is likely to be quickly unblocked.

　　2. It is possible to use fruits like kumquats and hawthorns to regulate qi and relieve depression.

　　Three, what foods should children with bloating avoid

　　1. It is advisable to avoid eating foods that contain gas, such as egg and milk products, whipped cream, whipped sugar protein, and soda. Some people think that drinking soda can help people belch, but in fact, although belching can make people feel better, most of the gas is still in the intestines.

　　2. It is advisable to avoid eating foods that produce gas easily, such as radishes, onions, cabbage, legumes, sweet potatoes, honey, chives, scallions, garlic, kohlrabi, celery, etc. The reason radishes cause bloating is that they contain pungent sulfur compounds, which, after fermentation in the intestines, produce hydrogen sulfide and thiol, inhibiting the absorption of carbon dioxide. Sweet potatoes contain amylase and plant fibers, so gas is produced in the intestines. Plant fibers are not easily digested and are easily fermented by bacteria into carbon dioxide and hydrogen. Foods rich in soybeans cause bloating because they contain water-soluble sugars like stachyose and raffinose, which cannot be digested and are easily fermented by microorganisms to produce gas. However, when soybeans are made into tofu, these sugars are dissolved in water and lost, so they rarely cause bloating.

　　3. Avoid indigestion. When indigestion occurs, reasonable dietary control should be carried out. Bloating should reduce the amount of sucrose and bloating foods such as milk in the diet.

　　4. Some individuals have habitual gastrointestinal bloating. In addition to the above foods, attention should also be paid to which foods can cause bloating, try to eat less of these foods, as individual differences, each person's sensitivity to food is different, so attention should be paid to observation.

　　1. Eat less food that produces gas in the gastrointestinal tract Foods like potatoes, bread, and sugar are easy to produce gas in the gastrointestinal tract, which eventually leads to bloating.

　　2. Do not eat indigestible foods Fried beans, hard pancakes, and other hard foods are not easy to digest and tend to stay in the gastrointestinal tract for a longer time, possibly producing more gas and causing bloating.

　　3. Good eating habits Change the habit of eating too fast, as eating too fast or eating while walking is easy to swallow a lot of air; drinking beverages with a straw can also let a lot of air sneak into the stomach, causing bloating.

　　4. Prevent negative emotions Anxious, worried, sad, despondent, and depressed negative emotions may weaken digestive function or stimulate the stomach to produce too much stomach acid.

　　5. Strengthen physical fitness Pay attention to physical exercise,坚持适量室外运动，not only helps to overcome negative emotions, but also helps the digestive system maintain normal function.

　　6. Moderately supplement fiber foods High-fiber foods can sometimes alleviate bloating, especially after consuming high-fat foods. This is because high-fat foods are difficult to digest and absorb, and therefore tend to stay in the gastrointestinal tract for a longer time. Once fiber is added, the blocked digestive system is likely to be quickly unblocked.

　　7. Prevent gastrointestinal diseases For some diseases, bloating may be a sign or one of the symptoms, such as allergic colitis, ulcerative colitis, and so on.