3.1 Abdo Pain in Children

Question 1

12 medical causes of abdo pain?

Answer 1

In over 5yrs non-organic or functional abdo pain is very common.

Other causes medical /surgical need to be ruled out:

MEDICAL:

• constipation
• UTI
• coeliacs
• IBD
• IBS
• mesenteric adenitis
• abdominal migraine
• pyelonephritis
• Henoch-Schonlein purpura
• tonsilitis
• DKA
• infantile colic

Question 2

What are some surgical causes of abdominal pain?

Answer 2

SURGICAL:

• appendicitis
• intussusception
• bowel obstruction
• testicular torsion

Question 3

central abdominal pain spreading to the right iliac fossa?

Answer 3

appendicitis

Question 4

non specific pain and red currant jelly stools?

Answer 4

Intussusception

Question 5

pain, distention, absolute constipation and vomiting?

Answer 5

bowel obstruction

Question 6

sudden onset, unilateral testicular pain, nausea and vomiting?

Answer 6

testicular torsion

Question 7

What are some red flags for serious abdo pain?

Answer 7

• persistent or bilious vomiting
• severe chronic diarrhoea
• fever
• rectal bleeding
• weight loss or faltering growth
• dysphagia (difficulty swallowing)
• nighttime pain
• abdominal tenderness

Question 8

5 investigations in abdo pain and what pathology they might show?

Answer 8

• Raised faecal calprotectin; IBD
• Raised ESR and CRP; IBD
• Anaemia; IBD or coeliac disease
• Raised anti-TTG or anti-EMA antibodies; coeliac disease
• Positive urine dipstick; UTI

Question 9

What is recurrent abdo pain? How to manage it?

Answer 9

type of functional or non-organic pain.

Overlap with abdo migraine, IBS and functional abdo pain. Often from stressful life events, bullying, loss of relative etc.

• distract
• dont focus or ask about pain
• good diet and hydration
• probiotics can help with IBS
• avoid NSAIDs
• address psychological and triggers

Question 10

What is an abdominal migraine?

Answer 10

More common in kids, often before they develop migraines as an adult.

Episodes of central abdo pain for >1hr.

May have;

• nausea and vomit,
• anorexia,
• pallor,
• headache,
• photophobia,
• aura.

Question 11

Treatment for acute abdominal migraine?

Answer 11

ACUTE attack:

• low stimulus (quiet, dark room)
• paracetamol
• ibuprofen
• sumatriptan

Question 12

Preventative treatment for abdominal migraine?

Answer 12

PREVENTATIVE meds:

• pizotifen (serotonin agonist)
• propranolol
• cyproheptadine (antihistamine)
• flunarazine (CCCB)

PIZOTIFEN is the main one to remember, withdraw slowly otherwise, anxiety, poor sleep, depression and tremor.