Symptoms of swollen lymph nodes in the baby's abdomen

Many of us are first-time parents. There are many things we don’t understand as our children grow up, and we are constantly exploring and accumulating experience. Especially when children are sick, we are all very worried and feel that the condition is very serious. We are unable to share the pain with the baby and think that the disease is very serious. Enlarged abdominal lymph nodes in children is a common pediatric emergency. Let’s take a closer look at this disease.

Abdominal lymphadenopathy in children is mostly caused by viral infection, which is more common in children under 7 years old in winter and spring. It often occurs during the course of acute upper respiratory tract infection or secondary to intestinal inflammation. Typical symptoms are fever, abdominal pain, vomiting, and sometimes diarrhea or constipation.

Typical symptoms include sore throat, fatigue and discomfort after an upper respiratory tract infection, followed by fever, abdominal pain, vomiting, and sometimes diarrhea or constipation. About 20% of children have swollen cervical lymph nodes. Abdominal pain is the earliest symptom of the disease. It can occur in any part of the body, but because the lesion mainly affects a group of lymph nodes in the terminal ileum, it is most common in the right lower abdomen. The nature of the abdominal pain is not fixed and can manifest as dull pain or spasmodic pain. The child feels better between two pains. The most sensitive tenderness site may be different in each physical examination. The tenderness site is close to the midline or higher, not fixed like in acute appendicitis, and is milder than in acute appendicitis, with less rebound pain and abdominal muscle tension. Occasionally, a small nodular mass with tenderness can be palpated in the right lower abdomen, which is an enlarged mesenteric lymph node. Some patients may have intestinal obstruction and should be carefully observed. For younger children who present with clinical symptoms similar to appendicitis but with milder symptoms and no abdominal muscle tension, acute mesenteric lymphadenitis should be considered. Generally, abdominal pain can be significantly improved after fasting, intravenous infusion, antibiotics, etc., and no surgical treatment is required. However, it is sometimes difficult to differentiate it from appendicitis. If symptoms do not improve after treatment and observation, surgical exploration is recommended. Acute mesenteric lymphadenitis should be considered in children with clinical fever, abdominal pain, vomiting and upper respiratory tract infection, or after intestinal inflammation without abdominal muscle tension.

Characteristics of the disease:

1. Most of them occur in complications of upper respiratory tract infection or intestinal infection, with clinical manifestations such as fever, abdominal pain, and vomiting.

2. Abdominal pain is most common in the right lower abdomen and is paroxysmal and spasmodic. Rebound pain and abdominal muscle tension are rare.

3. Abdominal tenderness is not fixed and may change with changes in body position.

4. Ultrasound examination showed enlarged mesenteric lymph nodes.

5. The diagnosis of this disease needs to be differentiated from acute abdominal diseases such as acute appendicitis, hyperperistalsis of the intestine, and ascariasis.

6. Children with a good prognosis after anti-inflammatory and antiviral treatment who develop high fever and abdominal pain during upper respiratory tract infection or intestinal infection should be considered to have the possibility of concurrent acute mesenteric lymphadenitis. Early abdominal B-ultrasound examination can clarify the diagnosis, prevent misdiagnosis of the disease, help to correctly deal with the disease, guide treatment, and improve efficacy.

Pathogenesis: Children's abdominal lymph nodes are distributed along the mesenteric artery and its arterial arch and are very abundant. The terminal ileum and ileocecal region are particularly affected. The contents of the small intestine often stay at the terminal ileum due to the action of the ileocecal valve, so intestinal bacteria and viral products are easily absorbed there.

Examination of white blood cells after onset may show normal or slightly elevated. Pathological manifestations include lymph node hyperplasia, edema, and congestion, but culture is often negative. Both bowel and urinary routine tests were normal. Ultrasound examination showed thickening of the abdominal mesentery and multiple enlarged mesenteric lymph nodes of varying sizes, mostly located in the right lower abdomen. They were smooth and intact in appearance, with clear boundaries between the cortex and medulla, and were hypoechoic. The echoes inside were uniform, and a small amount of fluid dark area was visible in the abdominal cavity. It can also differentiate acute appendicitis, pelvic inflammatory disease, and ovarian disease

Treatment: If the diagnosis has been confirmed, conservative treatment can be used. Generally, abdominal pain can be significantly improved and gradually recovered through fasting, intravenous infusion and antibiotics, and no surgical treatment is required. However, if symptoms do not improve after the above treatment, or if it is difficult to distinguish from acute appendicitis, surgical exploration is recommended. If an abscess forms or symptoms of peritonitis occur, surgical drainage is performed for those caused by Salmonella. Some children may develop intussusception and should be carefully observed. The most common gastrointestinal disease caused by Salmonella infection is gastroenteritis, and there are also reports of acute mesenteric lymphadenitis. Mesenteric lymphadenitis caused by Salmonella infection is different from viral lymphadenitis and is more common in children or adolescents. Lymph nodes invaded by bacteria often show acute inflammatory reactions, bleeding and necrosis in the lymph nodes, and Salmonella can be isolated in the lymph nodes. Conservative treatment should be performed first, and if an abscess is formed or symptoms of peritonitis appear, surgical drainage should be performed.

The prognosis is very good and most people recover without any specific treatment. Death is rare and may only occur when secondary specific bacterial infection occurs (suppuration caused by hemolytic streptococci, ruptured lymph nodes and the resulting abscesses and peritonitis).

Through the above introduction, we know what abdominal lymphadenopathy is in children. As long as the baby shows the above symptoms in life, it is best to send him to a regular hospital for examination. This disease cannot be solved at home. The baby’s physical fitness is still relatively poor. As parents, it is best for us to always observe and care for the baby to prevent the baby from being hurt.