Abdo pain and headache

Question 1

def. chronic abdo pain

Answer 1

long lasting intermittent or constant abdo pain that is functional or organic in nature

Question 2

3 major DDx of chronic abdo pain

Answer 2

1. organic GI disorders
2. organic non-GI disorders
3. Functional GI disorders

Question 3

what are organic non-GI disorders

Answer 3

things that cause pain to be referred to the abdo

Question 4

***RED flags for abdo pain

Answer 4

• weight loss
• oral ulcers
• bile or blood in vomit
• unexpalined fever
• pain at night
• melena
• hematochezia
• unexplained diarrhea
• acute abo - rebound, guarding
• anal tags/fissures
• joint Sx
• dysuria
• family Hx of GI disease
• dysphagia
• anemia
• hypoalbumenemia

Question 5

*what is key to ROME III criteria for FGID

Answer 5

no evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains Sx

Question 6

4 cats. of FGID

Answer 6

1. IBS - pain with improvement of def.
2. functional dyspesia - heart burn
3. abdo migraine - has periods of intervening health
4. functional abdo pain - insufficient crit for other 3

Question 7

what is diff. between functional abdo pain and FAP SYNdrome

Answer 7

same crit. as pain, but in addition cause 25% of time:

• loss of function
• additional somatic symptoms

Question 8

demographics of functonnal abdo pain

Answer 8

peak 10-12

• under 9 - M=F
• over 9 M

Question 9

features of functional abdo pain

Answer 9

• periumbilical
• unrelated to meals,activity
• does not wake
• normal growth
• no findings
• inteferes with school

Question 10

what tests for functional abdo

Answer 10

Hx and Px - if clear, then no other tests

Question 11

important social Hx

Answer 11

• relationships, home and school
• family funct.
• school performance
• mood, anxiety in parents

Question 12

3 general cats. of mgmt

Answer 12

1. pharma - for pain
2. CBT
3. dietary

Question 13

keys to mgmt

Answer 13

education! reassure

Question 14

prognosis for abdo pain

Answer 14

most improve, 1/3 go on

Question 15

epi of headache

Answer 15

• under 7 - 50% M>F

- over 7 - 70% F>M

Question 16

4 patterns of headache

Answer 16

1. acute
2. acute recurrent
3. chronic prog.
4. chronic non-prog.

Question 17

*** red flags for secondary headache

Answer 17

• under 3
• progressive
• increase with valsalva
• exposive or severe sudden
• systemic Sx
• suppressed, CA ,
• neuro Sx
• new or different severe headache
• sleep related

Question 18

5 primary headache syndrome

Answer 18

1. migraine
2, migraine with aura
3. other migraine
4. tension
5. chronic

Question 19

Sx of migraine

Answer 19

with or without aura

• attacks 30min -72hrs
• unilateral or bilateral
• moderate to severe
• nausea, photophobia

Question 20

Sx of tension

Answer 20

• most common
• bilateral
• pressure or tightening
• nild-moderate
• not worse with act.
• no nausea

Question 21

best test for ecurrent headache

Answer 21

Hx and Px

- imaging not reccomended for children with normal neuro exam

Question 22

keays to headache mgmt

Answer 22

• reasssure
• headache diary
• ID and avoid triggers
• aerobic excercise

Question 23

SMART headache magmt

Answer 23

Sleep
Meals
Activity
Relaxation
Trigger avoidance

Question 24

migraine MGMT

Answer 24

• sleep in dark quiet room

- aceto or advil at onset

Question 25

what is key to avoid rebound headache

Answer 25

limit ibu or aceto to 2-3 days per week