3 - Paeds - Gastro - Recurrent/Functional Abdo pain + CMPI + Toddler Diarrhoea

Question 1

Recurrent/Functional Abdo pain - how common? % school age kids? how bad + how long is pain?

Answer 1

common - 10% of school age kids

pain insufficient to interrupt ADLs and lasts for >3m

Question 2

Recurrent/Functional Abdo pain - where is pain? other Sx? many will have one of 3 things?

Answer 2

characteristically periumbilical pain, child otherwise entirely well
many have one of : IBS, abdominal migraine, functional dyspepsia

Question 3

Recurrent/Functional Abdo pain- What may be the cause? describe this cycle…

Answer 3

manifestation of stress/vicious cycle of anxiety with increasing pain > family distress/demand for Ix > anxiety
Anxiety can also > altered bowel motility > pain perception

Question 4

Recurrent/Functional Abdo pain - how to manage this patient?

Answer 4

ID any serious cause w/o unnecessary Ix
Full Hx/Ex + perineum inspection for fissures
Check growth

Question 5

Recurrent/Functional Abdo pain - What Ix should you do?

Answer 5

urine microscopy and culture to r/o UTI

Abdo USS to r/o gallstones and PUJ obstruction (pelvic ureteric junction)

Question 6

Recurrent/Functional Abdo pain - long term prog? Who is involved in the MDT?

Answer 6

50% rapid resolution
25% resolve in months
25% continue to adult, as migraine, IBS, or FD
Doctor, nurse, dietician, psychiatrist

Question 7

CMPI - Presentation? 3 main areas…

Answer 7

Cutaneous reactions (urticarial,  angioedema) 
GI reactions (D, N, V, colic, colitis, constipation)
Resp reactions (asthma, wheezing, laryngeal oedema)

Question 8

CMPI - possible FHx of what? timing of different Sx?

Answer 8

Atopy
immediate = rashes/resp reactions
later = GI Sx, cough/wheeze after 24h

Question 9

CMPI - MGMT? if severe? formula change?

Answer 9

stop CMP
use Ca supplements instead (Avoid eggs too)

if severe refer to specialist, change formula to AA formula

Question 10

CMPI - Clinical testing?

Answer 10

skin prick with CMP, bloods for total IgE and specific IgE for CMP

Question 11

Toddler Diarrhoea - Presentation?

Answer 11

preschool, chronic loose stools, some well formed some explosive and loose, presence of undigested veg in stools - otherwise children are well

Question 12

Toddler Diarrhoea - probably due to what?

Answer 12

maturational delay in intestine motility > intestinal hurry, not malabsorption

Question 13

Toddler Diarrhoea - mgmt

Answer 13

most grow out of by 5y - continence may be delayed -

Relief - ensure dietary fat and fibre to slow transit. Excessive fresh fruit juice can exacerbate