10.2 Recurrent abdominal pain in children Flashcards
most children with recurrent abdo pain is?
- don’t have organic disease
- mostly in the mind
what percentage of recurrent abdo pain syndrome (RAPS) after endoscopy acutally had something wrong?
~23%
IBS definition,3 main things
- non-ulcer dyspepsia
- diarrhoea/constipation
- recurrent central abdominal pain
enteric nervous system large?
largest outside CNS, more than spinal cord
how does RAPS happen?
- Sensitizing medical event: usually gastro
- genetic predisposition
- psychosocial events for pain reaction
management of RAPS?
- CBT - edu, relaxation, hyponotherapy
- diet
3, Meds: PPIs, antidepressants
-fix constipation
FODMAPS for?
fermentable fibres, gaseous distension
retrosternal pain plus dsphagia plus atopy, wakeing up at night, need to think of?
eosinophilic oesophagitis
reflux oesophagitis common? who gets it?
- less common now with PPIs
- ppl with cerebral palsy more likely
H. pylori complications? 4 ones?
- nodular gastritis
- PUD
- MALT lymphoma
- Ca stomach (no reported in kids) (strong family history)
most RAPS in childhood is?
IBS
H.pylori and abdo pain?
-no proven association
does h.pylori cause iron deficiency
-not likely
iron deficiency in kids non responsive to iron supplements:
needs endoscopy to rule out
GORD, coeliac, IBD, CMPI
how to test for H.Pylori?
- C-urea breath test
- stool antigen testing
- serum abx: tells you you’ve been infected at some point
- biopsy with histo
child who is losing weight, with elevated inflammatory markers and post-prandial recurrent abdo pain, need to think of?
- IBD
- Chrohn’s
gastrointestinal causes of RAPS? 4 main ddx
- GORD
- Biliary
- lactose intolerance
- Coeliac
approach for RAPS, what are red flags that stray you away?
- weight loss
- dysphagia
- waking up at night
- with meals
common RAPS symptoms?
headache
growing pains
dizzy spells
in RAPS and other GI presentations, mandatory to examine?
the anus
the abdo
If it’s IBS how diagnose?
history and examination, usually don’t need investigations`
