Chronic Abdominal pain

Question 1

Qualities of pain

Answer 1

P - position
Q - quality
R - radiation
S - severity
T - timing
A - alleviating
A - aggravating
A - associated sx

Question 2

Functional abdominal pain

Answer 2

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

Question 3

Ab pain in kids DON’T MISS

Answer 3

weight loss
decrease in growth
GI blood loss
vomiting
severe diarrhea
RUQ or RLQ recurrent pain
Unexplained fever
Fam Hx of inflammatory bowel disease

Question 4

Growth charts

Answer 4

important to plot the data points otherwise you may miss things

Question 5

Rectal Exams

Answer 5

perform if suspect:

• GI bleed
• intussusception
• rectal abscess
• impaction

Question 6

DDx for ab pain with bloody stools

Answer 6

Inflammatory bowel disease
Celiac disease
Bacterial Gastroenteritis
Giardiasis
Peptic Ulcer Disease
Henoch-Scholein Purpura

Question 7

IBD

Answer 7

severe, moderate, mild abdominal pain

- bloody stools are suggestive of IBD

Question 8

Celiac

Answer 8

children typically present 6-24 months with chronic abdominal pain, distention, diarrhea, anorexia, vomiting
- variable presentation

Question 9

Bacterial Gastroenteritis

Answer 9

Salmonella, shigella, campylobacter –> frequent causes of bloody diarrhea
C. diff another possible cause
- could have possible underlying colitis

Question 10

Giardiasis

Answer 10

parasite –> causes chronic abdominal pain
TRAVEL HISTORY
- can cause bloody stools but not as likely

Question 11

Peptic Ulcer Disease

Answer 11

relatively uncommon in kids but can cause bloody stools

- should be on differential

Question 12

Henoch-Schonlein Purpura

Answer 12

abdominal pain develops within days of rash

- half have (+) guaiac stool tests

Question 13

Labs for abdominal pain and bloody stools

Answer 13

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

Question 14

Anemia classification

Answer 14

Microcytic - iron deficiency –> low iron, high binding capacity
Normocytic - inflammation/infection causes decreased production of RBCs or lead poisoning

Question 15

Red Flag’s of Crohn’s Disease

Answer 15

pain waking child up, localized pain, involuntary weight loss
extraintestinal symptoms, (+) FamHx, abnormal bowel function

Question 16

Ulcerative Colitis

Answer 16

• relatively generalized inflammation to mucosa –> starting at rectum and advancing proximally
• crypt abscesses
• inflammation becomes more confluent

Question 17

Crohn’s Disease

Answer 17

• inflammation sporadic and can involve any part of alimentary tract
• patchy inflammation that can involve submucosa, muscularis or serosa
• transmural inflammation –> fistula

Question 18

Definitive diagnosis of UC or CD

Answer 18

combo of radiography and endoscopy

- upper endoscopy and colonoscopy

Question 19

Grading Crohn’s

Answer 19

# of diarrhea stools per day
daily abdominal pain
presence of symptoms
abdominal fullness
hematocrit
height and weight

Question 20

Etiology of IBD

Answer 20

typically presents in 3rd decade of life
25-30% in 2nd decade
5% before 10 years old
*most progress to relapsing/chronic disease

Question 21

Treating Crohn’s disease

Answer 21

Immunomodulators has become standard of care for children

• mild presentation –> aminosalicylate (1st line)
• corticosteroids are great at reducing inflammation and inducing remission

Question 22

Genetic Risk Factors for Crohn’s

Answer 22

Single greatest risk factor –> 1st degree relative with it

- there have been genes identified

Question 23

Extraintestinal manifestations of Crohn’s

Answer 23

arthritis
uveitis
renal involvement (kidney stones)
hepatic involvement
erythema nodosum