Gastro - functional abdo pain

Question 1

What is infant colic?

Answer 1

occurs during first few months of life.

Paroxysmal, inconsolable crying or screaming
often accompanied by drawing up of the knees and
passage of excessive flatus takes place several times a
day, particularly in the evening

Question 2

What is the classical presentation of recurrent abdominal pain?

Answer 2

Pain sufficient enough to interrupt normal activities and lasts for at least 3 months. Episodic or continuous.

Periumbilical pain
Otherwise well and no examinations point towards other causes of abdo pain

Question 3

Which examinations are required when investigating the cause for Recurrent Abdominal Pain? (cause found in < 10%)

Answer 3

Full abdominal exam.
Typically vague tenderness without guarding.
Inspect perineum for anal fissures/skin tags (IBD?)
Signs of anaemia, jaundice, mouth ulcers, skin rash, arthritis
Check weight and height (weightloss = redflag)

Question 4

Which investigations are required with possible recurrent abdominal pain?

Answer 4

Blood and stool for IBS
FBC (CRP, ESR and anti-endomysial antibodies)

Stool sample for giardia

Urine microscopy and culture
Abdominal US (gallstones and PUJ obstruction)

Question 5

How does recurrent abdominal pain recur during adulthood? (25% of cases)

Answer 5

Migraine
IBS
Functional dyspepsia

Question 6

What should be asked in a history enquiring into recurrent abdominal pain? (apart from basics)

Answer 6

Focus on GI and GU symptoms. Headache? (non-organic)

PMH important, including perinatal and neonatal.

ALARM SYMPTOMS
Persistent vomiting
Chronic severe diarrhoea
Unexplained fever
GI blood loss
Weight loss
Persistent RUQ or RLQ pain

pain is more suprapubic/flank if pain organic

Question 7

What is colic

Answer 7

Describes common symptoms which occur in first few months of life:
Paroxysmal, inconsolable crying/screaming accompanied by drawing up of the knewws and passage of excessive flatus

Takes place several times a day, particularly evening

In up to 40% of babies and usually resolves by 4 months

Question 8

Parental advice about colic

Answer 8

Benign, but can be frustrating

Reassure
Gripe water is often recommended, but benefit unproven
If severe and persistent, cow’s milk protein allergy or GORD may be the cause (try 2 weeks of whey hydrolysate formula)

Go to GP if worried (for advice)
Health visitor and family can also support

Question 9

Define recurrent (functional) abdominal pain and presentation (non-organic)

Answer 9

more than 2 discrete episodes in a 3 month period interfering with school and/or usual activities

short episodes of peri-umbilical pain, good appetite, no other GI symptoms, no FHx of migraine or coeliac disease and normal examination

co-existent symptoms such as headache and fatigue are common

Question 10

What are indicators for organic disease as a cause of recurrent abdo pain?

Answer 10

<2 yrs
Red flags:
Weight loss
Diarrhoea
Blood per rectum
Joint symptoms
Skin rashes
FHx of IBD or coeliac

Question 11

History in recurrent abdo pain

Answer 11

Atopy (asthma, eczema)
Relationship to eating
Precipitating factors (eg cow milk introduced?)
Social history (start school, parents splitting up, bullysin)
FH

Question 12

investigations for suspected organic cause in recurrent (functional) abdo pain

Answer 12

FBC
ESR/CRP
UE
LFT
Urine and faecal culture
Coeliac antibody screen

Question 13

MDT management of functional abdo pain

Answer 13

Doctor - diagnose, investigate, treat
Nurses - reassure, advice, monitor
Dietician - help with weight gain
Psychiatrist if non-organic