10.2 Recurrent abdominal pain in children

Question 1

most children with recurrent abdo pain is?

Answer 1

• don’t have organic disease

- mostly in the mind

Question 2

what percentage of recurrent abdo pain syndrome (RAPS) after endoscopy acutally had something wrong?

Answer 2

~23%

Question 3

IBS definition,3 main things

Answer 3

• non-ulcer dyspepsia
• diarrhoea/constipation
• recurrent central abdominal pain

Question 4

enteric nervous system large?

Answer 4

largest outside CNS, more than spinal cord

Question 5

how does RAPS happen?

Answer 5

• Sensitizing medical event: usually gastro
• genetic predisposition
• psychosocial events for pain reaction

Question 6

management of RAPS?

Answer 6

1. CBT - edu, relaxation, hyponotherapy
2. diet
   3, Meds: PPIs, antidepressants
   -fix constipation

Question 7

FODMAPS for?

Answer 7

fermentable fibres, gaseous distension

Question 8

retrosternal pain plus dsphagia plus atopy, wakeing up at night, need to think of?

Answer 8

eosinophilic oesophagitis

Question 9

reflux oesophagitis common? who gets it?

Answer 9

• less common now with PPIs

- ppl with cerebral palsy more likely

Question 10

H. pylori complications? 4 ones?

Answer 10

• nodular gastritis
• PUD
• MALT lymphoma
• Ca stomach (no reported in kids) (strong family history)

Question 11

most RAPS in childhood is?

Answer 11

IBS

Question 12

H.pylori and abdo pain?

Answer 12

-no proven association

Question 13

does h.pylori cause iron deficiency

Answer 13

-not likely

Question 14

iron deficiency in kids non responsive to iron supplements:

Answer 14

needs endoscopy to rule out

GORD, coeliac, IBD, CMPI

Question 15

how to test for H.Pylori?

Answer 15

• C-urea breath test
• stool antigen testing
• serum abx: tells you you’ve been infected at some point
• biopsy with histo

Question 16

child who is losing weight, with elevated inflammatory markers and post-prandial recurrent abdo pain, need to think of?

Answer 16

• IBD

- Chrohn’s

Question 17

gastrointestinal causes of RAPS? 4 main ddx

Answer 17

• GORD
• Biliary
• lactose intolerance
• Coeliac

Question 18

approach for RAPS, what are red flags that stray you away?

Answer 18

• weight loss
• dysphagia
• waking up at night
• with meals

Question 19

common RAPS symptoms?

Answer 19

headache
growing pains
dizzy spells

Question 20

in RAPS and other GI presentations, mandatory to examine?

Answer 20

the anus

the abdo

Question 21

If it’s IBS how diagnose?

Answer 21

history and examination, usually don’t need investigations`