Abdominal pain in children Flashcards
Non-organic/functional abdominal pain?
on-organic or functional abdominal pain is very common in children over 5 years. This is where no disease process can be found to explain the pain.
Medical causes of abdominal pain?
Other causes need to be excluded before diagnosing non-organic pain:
Constipation is also very common Urinary tract infection Coeliac disease Inflammatory bowel disease Irritable bowel syndrome Mesenteric adenitis Abdominal migraine Pyelonephritis Henoch-Schonlein purpura Tonsilitis Diabetic ketoacidosis Infantile colic
There are addition causes in adolescent girls:
Dysmenorrhea (period pain) Mittelschmerz (ovulation pain) Ectopic pregnancy Pelvic inflammatory disease Ovarian torsion Pregnancy
Surgical causes of abdominal pain?
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
Red flags for serious abdominal pain?
Persistent or bilious vomiting Severe chronic diarrhoea Fever Rectal bleeding Weight loss or faltering growth Dysphagia (difficulty swallowing) Nighttime pain Abdominal tenderness
Investigations for abdominal pain?
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
Recurrent abdominal pain?
A diagnosis of recurrent abdominal pain is made when a child presents with repeated episodes of abdominal pain without an identifiable underlying cause (non-organic/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.
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
What is an abdominal migraine?
Symptoms?
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
Treatment abdominal migraine?
It involves treating acute attacks and preventative measures.
Treating the acute attack:
Low stimulus environment (quiet, dark room)
Paracetamol
Ibuprofen
Sumatriptan
Preventative medications:
Pizotifen, a serotonin agonist
Propranolol, a non-selective beta blocker
Cyproheptadine, an antihistamine
Flunarazine, a calcium channel blocker
Pizotifen is the main preventative medication to remember for abdominal migraine. It needs to be withdrawn slowly when stopping as it is associated with withdrawal symptoms such as depression, anxiety, poor sleep and tremor.
