Chronic Abdominal pain Flashcards
Qualities of pain
P - position Q - quality R - radiation S - severity T - timing A - alleviating A - aggravating A - associated sx
Functional abdominal pain
most common cause of abdominal pain in school-aged kids
- functional dyspepsia, abdominal migraine, irritable bowel
Diagnosis
- if no alarming symptoms, PE normal, stool sample negative
Ab pain in kids DON’T MISS
weight loss decrease in growth GI blood loss vomiting severe diarrhea RUQ or RLQ recurrent pain Unexplained fever Fam Hx of inflammatory bowel disease
Growth charts
important to plot the data points otherwise you may miss things
Rectal Exams
perform if suspect:
- GI bleed
- intussusception
- rectal abscess
- impaction
DDx for ab pain with bloody stools
Inflammatory bowel disease Celiac disease Bacterial Gastroenteritis Giardiasis Peptic Ulcer Disease Henoch-Scholein Purpura
IBD
severe, moderate, mild abdominal pain
- bloody stools are suggestive of IBD
Celiac
children typically present 6-24 months with chronic abdominal pain, distention, diarrhea, anorexia, vomiting
- variable presentation
Bacterial Gastroenteritis
Salmonella, shigella, campylobacter –> frequent causes of bloody diarrhea
C. diff another possible cause
- could have possible underlying colitis
Giardiasis
parasite –> causes chronic abdominal pain
TRAVEL HISTORY
- can cause bloody stools but not as likely
Peptic Ulcer Disease
relatively uncommon in kids but can cause bloody stools
- should be on differential
Henoch-Schonlein Purpura
abdominal pain develops within days of rash
- half have (+) guaiac stool tests
Labs for abdominal pain and bloody stools
CBC w/ diff - check for anemia
ESR - nonspecific for inflammation
Hepatic profile - malnutrition
IgA TTA - check for celiac disease (sens and spec)
Stool ova and parasite - especially with chronic sx
Stool culture - important to check if chronic symptoms and bloody stool
Anemia classification
Microcytic - iron deficiency –> low iron, high binding capacity
Normocytic - inflammation/infection causes decreased production of RBCs or lead poisoning
Red Flag’s of Crohn’s Disease
pain waking child up, localized pain, involuntary weight loss
extraintestinal symptoms, (+) FamHx, abnormal bowel function
Ulcerative Colitis
- relatively generalized inflammation to mucosa –> starting at rectum and advancing proximally
- crypt abscesses
- inflammation becomes more confluent
Crohn’s Disease
- inflammation sporadic and can involve any part of alimentary tract
- patchy inflammation that can involve submucosa, muscularis or serosa
- transmural inflammation –> fistula
Definitive diagnosis of UC or CD
combo of radiography and endoscopy
- upper endoscopy and colonoscopy
Grading Crohn’s
# of diarrhea stools per day daily abdominal pain presence of symptoms abdominal fullness hematocrit height and weight
Etiology of IBD
typically presents in 3rd decade of life
25-30% in 2nd decade
5% before 10 years old
*most progress to relapsing/chronic disease
Treating Crohn’s disease
Immunomodulators has become standard of care for children
- mild presentation –> aminosalicylate (1st line)
- corticosteroids are great at reducing inflammation and inducing remission
Genetic Risk Factors for Crohn’s
Single greatest risk factor –> 1st degree relative with it
- there have been genes identified
Extraintestinal manifestations of Crohn’s
arthritis uveitis renal involvement (kidney stones) hepatic involvement erythema nodosum
