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Child has tummy ache. X-ray showed enlarged liver. Cause of concern?

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Hi, my 3 year old daughter went to her pediatrician yesterday after complaining that her tummy hurts. We wanted to make sure it was nothing serious cos she has been saying that for 2 months and she ended up been impacted 2 weeks ago. At her doctor office he said he could feel her liver but ordered X-ray to rule out constipation but the X-ray shows her liver was a bit enlarged with no constipation. Her doctor said not to worry. Is it ok not too. Also two weeks ago when she was impacted, she had X-ray, sonogram, blood test and everything was normal, liver function ok, sonogram revealed normal size liver. Is this a cause for concern or not
Posted Tue, 11 Jun 2013 in Child Health
Answered by Dr. Sumitra Kumar Mukherjee 44 minutes later

Thanks for your query on XXXXXXX

I need to ask a few questions to help you better. I shall be grateful if you kindly let me know the following:
(1) Is the pain in upper abdominal or
(2)Is the pain in lower abdominal
(3)Is the pain colicky in nature or constant?
(4)Has she got normal bowel movement?
(4) Has she got high tempareture?
(5) Is the pain affecting whole abdomen or (R)lower abdomen?

Please revert back with answers. I will be happy to address your concerns.

Dr S.K.Mukherjee
Above answer was peer-reviewed by
Follow-up: Child has tummy ache. X-ray showed enlarged liver. Cause of concern? 2 hours later
Thanks a lot doctor for your response. I will reply ur questions below:

1. She usually says the it hurts in the center area of the upper abdominal area
2. She usually doesn't seem to be in pain except for the day we learnt she was impacted then she was in serious pain and crying. She usually just says it hurts and she keeps playing and she will be perfectly normal. Her doctor also says she might be using it to get attention as well cos there is a new baby on board.
3. She usually has at least 1 bowel movement everyday including the day we found out she was impacted and her poop size is large and not hard i.e she poops a lot for a 3 year old. It's confusing that despite all that she still got impacted and has had two other cases of constipation early last year.
4. No she doesn't have fever and she acts normal. She says it at random. Sometimes after eating or just at other time. She will later say her tummy is fine later but we wanted to make sure it wasn't a sign of something serious.
5. The pain doesn't affect the whole abdomen. She points only to the center of her upper abdomen.

Lastly, my husband just spoke to her doctor and he said its not that the liver is enlarged but its in a more prominent position that other kids. We asked how come this has never been mentioned before but no response to that. Is this something serious? He said its nothing to worry abt that he will just keep an eye on it at every examination.
Answered by Dr. Sumitra Kumar Mukherjee 13 hours later
Dear Madam Thank you for sending answers to my queries. I am sorry to send so many queries. It appears your daughter is suffering from Idiopathic constipation. The term "Idiopathic" means "Unknown" The suggested causes are

(1)Diet: Most commonly not eating enough fibres and enough drink and as a result, the stool gets harder.
(2) Stool holding: The child gets urge to pass motion but deliberately holds the motion.Longer the child holds the motion the stool will be bigger and the child will get more pain in passing the motion.
(3)Emotional problem: Constipation with impaction leads to recurrent distress in passing motions. The child may soils pants regularly due to overflow incontinence with very soft stool. The child may get irritable, does not eat properly, complains abdominal pain and generally feels unwell. Impacted stool may be palpable on examination of abdomen.
Management and treatment: Your doctor will prescribe adequate laxative to soften the stool. For impaction your child may need higher doses initially to clear large bulk of faeces blocking rectum and preventing impaction. In course of time, the rectum will get back to normal size and the constipation will less likely to occur. It may take few months to recover. As regard her liver, I agree with your doctor if the child does not show any clinical problem she is okay. Kindest regards Dr.S.K.Mukherjee
Above answer was peer-reviewed by
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