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What Causes Persistent Pain In Navel Area And Anorexia In A Child?
Question: My five year old constantly complains of a sore tummy. She is off her food and can be up through the night in agony pulling her little legs up to her tummy. I have had her at gp and he thinks it could be a grumbling appendicitis. The pain is around her naval area and she can feel very nauseous but never actually sick. When she is in pain the colour drains from her face and she looks unwell always comes upon her after eating
Brief Answer:
Some questions:
Detailed Answer:
Hello and welcome,
I am sorry that your little girl is having these concerning symptoms. I have a few questions for you and can provide better information after I hear back:
When did the pain start (how long has she had this)?
When was she seen by her doctor for this?
Has it worsened since she was last seen by the doctor?
Does she ever get fevers?
Is it getting progressively worse?
Does her abdomen hurt when she walks?
Is it worse after any particular foods?
Does it hurt to press on her tummy, particularly on the lower right side?
Is it much worse after eating?
Has she been moving her bowels regularly?
Thanks - information will follow.
Some questions:
Detailed Answer:
Hello and welcome,
I am sorry that your little girl is having these concerning symptoms. I have a few questions for you and can provide better information after I hear back:
When did the pain start (how long has she had this)?
When was she seen by her doctor for this?
Has it worsened since she was last seen by the doctor?
Does she ever get fevers?
Is it getting progressively worse?
Does her abdomen hurt when she walks?
Is it worse after any particular foods?
Does it hurt to press on her tummy, particularly on the lower right side?
Is it much worse after eating?
Has she been moving her bowels regularly?
Thanks - information will follow.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Pain started as a dull pain about three months ago and changed to extremely painful about three weeks ago when seen by doctor. Definitely got worse from that and has been back twice. Fever yes where her temperature is up and down that has only been last few days so took her to er room they did bloods and they have come back clear as has her urine. She is fine to walk. It would be worse after eating in general to the point now there is no appetite. Her right side is ok pain solely at the naval area and very painful to press. Yesterday no bowel movement but before that twice daily.
Brief Answer:
Needs further evaluation now.
Detailed Answer:
I am concerned that the symptoms have gotten worse with some fever and increased pain. While she may have had chronic appendicitis (or grumbling appendicitis), this may be progressing. The typical signs of any appendicitis are abdominal pain, nausea, and intermittent or constant fever. In little kids, the pain is not always localized to the right lower quadrant but can be around the navel until later when it goes to the right lower quadrant of the abdomen. The CBC (complete blood count) may show an elevation of white blood cells, but may also be ok.
With acute appendicitis, the pain really does not go away and progresses over hours to a few days.
At this point I would strongly recommend imaging studies - an abdominal ultrasound, or a CT - which can help sort out what is going on when symptoms of appendicitis are equivocal. And I am also thinking at least a consult with a pediatric surgeon or a pediatric gastroenterologist. I don't know how things work in ERs in the UK, but in the US, the ER doctor will call in a surgeon to examine the patient (not necessarily to operate, but to evaluate a patient who may be having appendicitis). So please take her back - this little girl needs further work up than blood and urine tests.
Please let me know how she is doing later.
Needs further evaluation now.
Detailed Answer:
I am concerned that the symptoms have gotten worse with some fever and increased pain. While she may have had chronic appendicitis (or grumbling appendicitis), this may be progressing. The typical signs of any appendicitis are abdominal pain, nausea, and intermittent or constant fever. In little kids, the pain is not always localized to the right lower quadrant but can be around the navel until later when it goes to the right lower quadrant of the abdomen. The CBC (complete blood count) may show an elevation of white blood cells, but may also be ok.
With acute appendicitis, the pain really does not go away and progresses over hours to a few days.
At this point I would strongly recommend imaging studies - an abdominal ultrasound, or a CT - which can help sort out what is going on when symptoms of appendicitis are equivocal. And I am also thinking at least a consult with a pediatric surgeon or a pediatric gastroenterologist. I don't know how things work in ERs in the UK, but in the US, the ER doctor will call in a surgeon to examine the patient (not necessarily to operate, but to evaluate a patient who may be having appendicitis). So please take her back - this little girl needs further work up than blood and urine tests.
Please let me know how she is doing later.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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