Abdominal pain

Question 1

Recurrent bouts of periumbilical pain, vomiting, diarrhea, fever, headache, and low pulse rate may be what confusing diagnosis?

Answer 1

Abdominal migraine

Question 2

Recurrent bouts of periumbilical pain, vomiting, diarrhea, fever, headache, and low pulse rate may be what confusing diagnosis?

Answer 2

Abdominal migraine

Question 3

What is the natural course of abdominal migraine?

Answer 3

Usually outgrown by adolescence

Question 4

How long does an episode of abdominal migraine usually last?

Question 5

What medications are helpful in the prevention of abdominal migraine (if episodes are very frequent)?

Answer 5

SSRIs

β-blockers

Tricyclic antidepressants

Question 6

What medications are useful in the treatment of an acute episode of abdominal migraine?

Answer 6

The same ones used for regular migraine

NSAIDs, ergotamines, antihistamines, etc.

Question 7

What is the natural course of abdominal migraine?

Answer 7

Usually outgrown by adolescence

Question 8

How long does an episode of abdominal migraine usually last?

Question 9

What medications are helpful in the prevention of abdominal migraine (if episodes are very frequent)?

Answer 9

SSRIs

β-blockers

Tricyclic antidepressants

Question 10

What medications are useful in the treatment of an acute episode of abdominal migraine?

Answer 10

The same ones used for regular migraine

NSAIDs, ergotamines, antihistamines, etc.

Question 11

In children with abdominal pain, what historical features suggest a possible organic or serious cause?

Answer 11

• Involuntary weight loss
• Deceleration of linear growth
• GI blood loss
• Significant vomiting (e.g., bilious emesis, hematemesis, protracted vomiting, cyclical vomiting, pattern concerning to physician)
• Chronic severe diarrhea
• Alarm signs on abdominal examination (right upper or lower quadrant tenderness, localized fullness or mass effect, peritoneal signs, hepatomegaly, splenomegaly, costovertebral angle tenderness)
• Unexplained fevers
• Family history of inflammatory bowel disease or other significant GI illnesses
• Presentation of symptoms before 4 years or after 15 years of age

Question 12

What treatments are used for functional abdominal pain in children?

Answer 12

Dietary: Low-lactose diets, dietary fiber, low-fructose diets, probiotics
• Pharmacologic: Antidepressants, antispasmodics, prokinetic agents, H2-receptor antagonists, leukotriene-receptor antagonists
• Psychological: Cognitive behavioral therapy, family intervention, relaxation and distraction techniques
• Complementary and alternative medicine: Herbal medicine, peppermint oil, biofeedback, hypnotherapy, massage therapy, acupuncture