One detail was ignored. Duodenal perforation occurred 2 days after enteritis in children

Jiang XX, a 5-year-old female, suffered from fever, abdominal pain for 5 days, rash for 3 days, vomiting and diarrhea for 2 days 15: He was admitted to the hospital with “dehydration of enteritis and electrolyte disorder, urticaria” in our hospital. There was no obvious cause of fever 5 days ago. The temperature was as high as 38.2 ℃. Taking antipyretic drugs could reduce to normal, accompanied with abdominal pain, obvious periumbilical, paroxysmal attack. He was given oral drug treatment at home, and did not have fever again. He developed rash, wheeze like rash, pruritus, vomiting and vomiting 2 days ago The vomit was stomach content, accompanied by diarrhea. He was given drug infusion at home, but still had abdominal pain. The outpatient department was admitted to our ward with “infantile enteritis, dehydration and electrolyte disorder, urticaria”. < / P > < p > since the onset of the disease, the child has a clear mind, slightly poor spirit, poor eating and sleeping, reduced urination, dry skin and mucous membrane, dry lips, and scattered rash on the face. After admission, complete the auxiliary examination and give symptomatic treatment such as rehydration. Blood routine examination showed that white blood cell: 28.24 × 10 ^ 9 / L; C-reactive protein: 214.57 mg / L; serum amyloid protein: 301.79 mg / L; procalcitonin 1.05 ng / ml. after admission, the child’s defecation was black stool, and complained of abdominal pain. According to the doctor’s advice, the abdomen B-ultrasound examination, stool examination, abdominal B-ultrasound showed no abnormality, stool showed: occult blood, white blood cells 8-10. < p > < p > 7.30 reexamination of blood routine and improvement of other related examinations after admission. Children with fever, diarrhea, nausea, vomiting, consider the presence of enterovirus infection, give rehydration symptomatic treatment, inform the children’s family members of diet, rest and precautions, patients and their families understand. < p > < p > 7.31. The child had mental health, poor spirit, repeated abdominal pain during the day. The body temperature was 36.1 ℃, the pain score was 5 points, and the blood pressure was 103 / 71mmhg, Oxygen saturation 99%, heart rate 80 beats / min, inform the doctor on duty, according to the doctor’s advice, give belladonna 3ml orally, give 5% gs100ml + butylbromobenzolamine 5mg intravenous drip, ask family members to give children temporary fasting, ask pediatric surgery consultation, if there is any surgical risk, it is recommended to transfer to surgery. The patient was given abdominal pain by CT, and the patient was still suspected to have abdominal pain after abdominal cavity puncture. They were transferred to pediatric surgery for surgical treatment. Acute perforation of gastroduodenal ulcer is a serious complication of intestinal ulcer. It has a rapid onset, rapid change and serious condition. It needs emergency treatment. If the diagnosis and treatment is improper, it can endanger life. After acute perforation, digestive juice and food with strong irritation such as gastric acid, bile and pancreatic juice enter the abdominal cavity, causing chemical peritonitis and large amount of fluid leakage in the abdominal cavity, about 6-8 hours After that, the bacteria began to propagate and gradually turned into purulent peritonitis. Due to severe abdominal pain, strong chemical stimulation, loss of extracellular fluid and absorption of bacterial toxin, the patient may have shock. < / P > < p > 2. The main symptoms of perforation are sudden upper abdominal knife cut like pain, and quickly spread to the whole abdomen, but the upper abdomen is heavy, the patient has unbearable pain, and has pale complexion, cold sweat, fine pulse, blood pressure drop, limbs chills and other manifestations, often accompanied by nausea and vomiting. When intestinal perforation occurs in children, the children have severe abdominal pain, abdominal distention, pale face, pulse and so on The heart rate increased. Upper gastrointestinal bleeding refers to gastrointestinal bleeding above the Treitz ligament. The bleeding performance is hematemesis or bloody stool or both. When the amount of bleeding is more than 5ml, stool occult blood test is positive. Small amount of bleeding may not have obvious systemic symptoms. Massive bleeding can lead to shock and anemia. Scopolamine and anticholinergic drugs are mainly used to relieve smooth muscle spasm, gastrointestinal colic, biliary spasm, acute microcirculation disturbance and organophosphorus poisoning, etc. if the diagnosis of acute abdomen is not clear, it should not be used easily. Nursing staff should pay attention to the test results, blood routine test showed that white blood cell: 28.24 × 10 ^ 9 / L; C-reactive protein: 214.57 mg / L; serum amyloid protein: 301.79 mg / L; procalcitonin 1.05 ng / ml, fecal occult blood, white blood cells 8-10, etc. these laboratory results suggest that we should focus on the observation of the child. < p > < p > 2. Due to the children’s younger age, they can not accurately tell the nature and location of abdominal pain, so it is particularly important to observe the condition, and nurses should know the focus of observation of children with abdominal pain. Infantile abdominal pain is one of the common clinical manifestations in pediatrics. It has the characteristics of acute onset, rapid change, serious and complex condition, and it needs emergency treatment. Moreover, the infant’s language expression ability is poor, and the discomfort is often expressed by crying. During nursing observation, we should recognize the particularity of infants, observe carefully, accurately and timely the potential danger signals, and closely observe the location, degree and nature of pain Objective to provide the basis for diagnosis and timely treatment of children. < / P > < p > acute gastroenteritis abdominal pain, mainly in the upper abdomen and around the navel, often presents persistent pain with paroxysmal aggravation. Often accompanied by nausea, vomiting, diarrhea, but also fever. Can have epigastric or umbilicus around tenderness, more no muscle tension, more no rebound pain, bowel sounds slightly hyperactive. < / P > < p > most patients with acute appendicitis had persistent dull pain in the middle and upper abdomen at the onset of the disease, and the abdominal pain was transferred to the right lower abdomen a few hours later, presenting persistent dull pain with paroxysmal aggravation. A few patients felt right lower abdominal pain at the onset of the disease. The characteristic of acute appendicitis abdominal pain is that the middle upper abdominal pain transfers to the right lower abdominal pain after several hours, accounting for about 70% to 80% of acute appendicitis abdominal pain. It may be accompanied by nausea, vomiting or diarrhea. Severe patients may have fever, fatigue, poor spirit. The fixed tenderness point of right lower abdomen is the most important sign for the diagnosis of acute appendicitis, and the typical tenderness is the tenderness at the Maxwell’s point or accompanied by muscle tension and rebound pain. Most patients with acute pancreatitis have a history of cholelithiasis, with persistent pain in the upper abdomen, which radiates to the lower back, and may have nausea and vomiting; severe patients with abdominal pain rapidly spread to the whole abdomen, often with fever, and early shock or multiple organ dysfunction syndrome. Epigastric tenderness or accompanied by muscle tension, rebound pain, jaundice, mobile voiced positive, periumbilical or lateral abdominal wall skin can appear purplish red ecchymosis. The perforation of gastric and duodenal ulcer is mainly middle and upper abdominal pain, most of which are persistent pain, and most of them attack on an empty stomach, which can be relieved after eating or taking antacids. Frequent attacks may be accompanied by fecal occult blood test positive. When acute perforation of ulcer occurs, sudden severe upper abdominal pain, such as knife like, persistent, and quickly spread to the whole abdomen in a short time, with nausea, vomiting, fever. There may be hematemesis or melena when accompanied by bleeding. Pylorus obstruction can vomit a lot of overnight food. However, there was no muscle tension or rebound pain in the upper and middle abdomen of patients without perforation. After perforation, abdominal tenderness, abdominal muscle tension, rebound pain, bowel sounds disappear, pneumoperitoneum sign and mobile voiced sound may appear, and the area of liver dullness will shrink or disappear. Abdominal X-ray film can find the gas in the lower part of diaphragm and abdominal puncture is helpful for diagnosis. It should be noted that gastrointestinal fluid in patients with perforated gastric and duodenal ulcer can flow to the right lower abdomen along the paraascending colic sulcus, which may show metastatic abdominal pain and should be differentiated from acute appendicitis. Those with chills and fever should be differentiated from liver abscess. In addition, the amylase in ascites of patients with ulcer perforation can be increased, which should be differentiated from acute pancreatitis. According to the positive signs of the children, we should not only consider the common diseases in the Department, but also consider whether there are other related diseases. Children’s abdominal pain is common in pediatrics, so we should actively look for the causes, do not blindly use some drugs to relieve abdominal pain, and communicate with doctors to avoid covering up the disease. Focus