Chronic (recurrent) Abdominal Pain

Question 1

Define chronic recurrent abdominal pain

Answer 1

episodes of abdominal pain at least 4 times per months, sufficient enough to interrupt normal activities and lasts for at least 2 months

Question 2

Give examples of functional abdominal pain disorders

Answer 2

Irritable bowel syndrome
Abdominal migraine
Functional dyspepsia
Functional abdominal pain (not otherwise specified)

Question 3

Differentials for chronic abdominal pain

Answer 3

Functional abdominal pain
GI: constipation, peptic ulcer disease, eosinophilic oesophagitis, IBD, malrotation, giardiasis
Hepatobiliary: hepatitis, gall stones
Urinary: UTI, PUJ obstruction, renal calculi
Gynae: dysmennorrhoea, ovarian cysts, PID

Question 4

What features suggest organic chronic abdominal pain

Answer 4

Pain is during the day and night
Weight loss and/or reduced appetite
Lack of energy
Recurrent fever
Organ-specific e.g. change in bowel habit, polyuria, menstrual symptoms, vomiting
Occult or frank blood
FHx of GI problems

Question 5

What features suggest non-organic chronic abdominal pain

Answer 5

Periodic pain with intervening good health
Often periumbilical pain
Psychosomatic: may be related to school hours
Otherwise healthy
Improves on weekends and school holidays

Question 6

What investigations should be done if functional abdominal pain is suspected

Answer 6

Basic routine Ix:
- Stool MC&S
- FBC, ESR, LFTs

+ thorough examination

Question 7

What is the general management for functional abdominal pain

Answer 7

Explain and re-assure
Keep a diary of symptoms
Pain management: relaxation, distraction, graded return to activities/school
Address contributory factors: avoid reinforcement, non-pain-based shared activities, reduce stresses in school/peer interactions
Treat any co-morbidities e.g. anxiety, depression
Consider dietary interventions: probiotics
Consider family CBT

Question 8

What is the prognosis for functional abdominal pain

Answer 8

50% of children improve following the initial consultation
Symptoms remain in 15% of children

Question 9

Describe the paediatric pain pathway

Answer 9

Level 1: manage stress, tiredness, diet, general health (sleep, exercise) ± paracetamol/NSAIDs
Level 2: physio, psychologist, consider probiotic use
Level 3: CAMHS, rehab, pain, opioids, surgical intervention e.g. nerve blocks

Question 10

What are the signs and symptoms of IBS

Answer 10

NOn-specific abdominal pain (often peri-umbilical)
Defecation issues
Alteration in stool frequency
Feeling of incomplete defecation – tenesmus
Change in appearance of stool
Bloating

Question 11

What are the signs and symptoms of abdominal migraines

Answer 11

Paroxysms of intense acute periumbilical, midline or diffuse abdominal pain
- Lasts at least an hour
- Interferes with normal activities
Vomiting and nausea
Anorexia
Headaches
Photophobia
Pallor
Long periods in between of no symptoms