abdo pain and constipation in children

Question 1

what are medical causes of abdominal pain?

Answer 1

• constipation
• UTI
• coeliac
• IBD
• IBS
• mesenteric adenitis
• HSP
• Tonsilitis
• Infantile colic

Question 2

what are causes of abdominal pain specific to adolescent girls?

Answer 2

• dymenorrhoea
• mittleschmerz
• ectopic pregnancy
• PID
• ovarian torsion
• pregnancy

Question 3

what are surgical causes of abdominal pain?

Answer 3

• appendicitis
• intususseption- redcurrent jelly stool- pain is colicky and non specific
• bowel obtstuction- pain, distention, absolute constipation and vomiting
• testicular torsion- unilateral with nausea and vomitting

Question 4

what are some initial investigations for abdominal pain and what would they suggest?

Answer 4

Anaemia can indicate inflammatory bowel disease or coeliac disease

Raised inflammatory markers (ESR and CRP) can indicate inflammatory bowel disease

Raised anti-TTG or anti-EMA antibodies indicates coeliac disease

Raised faecal calprotectin indicates inflammatory bowel disease

Positive urine dipstick indicates a urinary tract infection

Question 5

what is non functional abdominal pain?

Answer 5

• reccurrent abdominal pain without an identifiable cause

- often corresponds to stressful life events

Question 6

what is the management for nonidentifiable addominal pain?

Answer 6

• careful explaination and reassurance
• distraction with other activities
• regular sleeping, meals and balanced diet
• avoid NSAIDS and ibuprofen
• school support
• address triggers

Question 7

what are features of abdominal migraine?

Answer 7

young children may present like this first and then get migraines when they are older

central abdo pain>1 hour which may be associated with:

• N&V
• anorexia
• headache
• photophobia
• aura

Question 8

how can an acute abdominal migraine attack be treated?

Answer 8

• low stimulus environement- quite dark room
• paracetamol
• ibuprofen
• sumatriptan

Question 9

what are preventative medications for abdominal migraine?

Answer 9

• Pizotifen, a serotonin agonist (needs to be withdrawn slowly)
• Propranolol, a non-selective beta blocker
• Cyproheptadine, an antihistamine
• Flunarazine, a calcium channel blocker

Question 10

what ar the side effects of withdrawing pizotifen quickly?

Answer 10

• depression
• anxiety
• poor sleep
• tremor

Question 11

what is retentive posturing?

Answer 11

• if are constipated then will have straight legs, be on tip-toes with back arched

Question 12

what is overflow soiling?

Answer 12

• incontinence with loose smelly stool s due to faecal impaction stretching the rectum

constipation can also lead to the loss of sensation of needing to open the bowels as they become desensitised over time

Question 13

what is the term for faecal incontinence?

Answer 13

encopresis

Question 14

when is faecal incontinence deemed pathological?

Answer 14

over age 4

Question 15

what are other causes of encopresis apart form constipation?

Answer 15

Spina bifida
Hirschprung’s disease
Cerebral palsy
Learning disability
Psychosocial stress
Abuse

Question 16

what are red flags in a constipation history?

Answer 16

• Not passing meconium within 48 hours of birth (cystic fibrosis or Hirschsprung’s disease)
• Neurological signs or symptoms, particularly in the lower limbs (cerebral palsy or spinal cord lesion)
• Vomiting (intestinal obstruction or Hirschsprung’s disease)
• Ribbon stool (anal stenosis)
• Abnormal anus (anal stenosis, inflammatory bowel disease or sexual abuse)
• Abnormal lower back or buttocks (spina bifida, spinal cord lesion or sacral agenesis)
• Failure to thrive (coeliac disease,
• hypothyroidism or safeguarding)
• Acute severe abdominal pain and bloating (obstruction or intussusception)

Question 17

what are lifestyle factors that influence constipation

Answer 17

Habitually not opening the bowels
Low fibre diet
Poor fluid intake and dehydration
Sedentary lifestyle
Psychosocial problems such as a difficult home or school environment (always keep safeguarding in mind)

Question 18

how can constipation be managed?

Answer 18

• high fibre diet and good hydration
• movicol is first line- osmotic laxative …should not be given long term and should be weaned off
• disimpaction regimine if impacted (with high dose of laxatives first line)
• schedule visits to toilet and star charts