Abdominal Pain Flashcards
Give examples of medical causes of abdominal pain in children
- Constipation
- Urinary tract infection
- Coeliac disease
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
- Abdominal migraine
- Pyelonephritis
- Henoch-Schonlein purpura
- Tonsilitis
- Diabetic ketoacidosis
- Infantile colic
Give examples of medical causes of abdominal pain in adolescent girls
- Dysmenorrhea (period pain)
- Mittelschmerz (ovulation pain)
- Ectopic pregnancy
- Pelvic inflammatory disease
- Ovarian torsion
- Pregnancy
Give examples of surgical causes of abdominal pain in children
- Appendicitis
- Intussusception
- Bowel obstruction
- Testicular torsion
Briefly differentiate between the pain in appendicitis, intussusception, bowel obstruction and testicular torsion
Appendicitis causes central abdominal pain spreading to the right iliac fossa.
Intussusception causes colicky non-specific abdominal pain with redcurrant jelly stools.
Bowel obstruction causes pain, distention, absolute constipation and vomiting.
Testicular torsion causes sudden onset, unilateral testicular pain, nausea and vomiting.
What are the red flags for abdominal pain in children?
- Persistent or bilious vomiting
- Severe chronic diarrhoea
- Fever
- Rectal bleeding
- Weight loss or faltering growth
- Dysphagia (difficulty swallowing)
- Nighttime pain
- Abdominal tenderness
What intial investigations should be ordered for abdominal pain?
Initial investigations:
- Anaemia screen
- Inflammatory markers (ESR and CRP)
- Anti-TTG or anti-EMA antibodies
- Faecal calprotectin
- Urine dipstick
What may anaemia indicate?
Anaemia can indicate inflammatory bowel disease or coeliac disease.
What may raised inflammatory markers (ESR and CRP) indicate?
Raised inflammatory markers (ESR and CRP) can indicate inflammatory bowel disease.
What may raised anti-TTG or anti-EMA antibodies indicate?
Raised anti-TTG or anti-EMA antibodies indicates coeliac disease.
What may raised faecal calprotectin indicate?
Raised faecal calprotectin indicates inflammatory bowel disease.
What may positive urine dipstick indicate?
Positive urine dipstick indicates a urinary tract infection.
Briefly describe recurrent abdominal pain in children and its causes
A diagnosis of recurrent abdominal pain is made when a child presents with repeated episodes of abdominal pain without an identifiable underlying cause. The pain is described as non-organic or functional. This is common and can lead to psychosocial problems, such as missed days at school and parental anxiety. There is overlap between the diagnoses of recurrent abdominal pain, abdominal migraine, irritable bowel syndrome and functional abdominal pain.
Recurrent abdominal pain often corresponds to stressful life events, such as loss of a relative or bullying. The leading theory for the cause is increased sensitivity and inappropriate pain signals from the visceral nerves (the nerves in the gut) in response to normal stimuli.
Briefly describe the management of recurrent abdominal pain
Management involves careful explanation and reassurance. Measures that can help manage the pain are:
- Distracting the child from the pain with other activities or interests
- Encourage parents not to ask about or focus on the pain
- Advice about sleep, regular meals, healthy balanced diet, staying hydrated, exercise and reducing stress
- Probiotic supplements may help symptoms of irritable bowel syndrome
- Avoid NSAIDs such as ibuprofen
- Address psychosocial triggers and exacerbating factors
- Support from a school counsellor or child psychologist
Briefly describe abdominal migraines
Children are more likely than adults to suffer with a condition called abdominal migraine. This may occur in young children before they develop traditional migraines as they get older. Abdominal migraine presents with episodes of central abdominal pain lasting more than 1 hour. Examination will be normal.
There may be associated:
- Nausea and vomiting
- Anorexia
- Pallor
- Headache
- Photophobia
- Aura
Briefly describe the acute management of an abdominal migraine
Treating the acute attack:
- Low stimulus environment (quiet, dark room)
- Paracetamol
- Ibuprofen
- Sumatriptan
