Paeds: Recurrent abdo pain in children Flashcards
1
Q
Differentials:
A
- Abdominal Migraine
- The 90%:
a. Psychological
b. Cycle: Anxiety and escalation leading to pain, create family distress, demands for investigation, more anxiety.
c. IBS
d. Non-ulcer dyspepsia
e. Abdo migraine - Gastritis and Peptic Ulceration
2
Q
Abdominal Migraine:
Definition
A
- Cranial migraine often associated with abdo pain in addition to headaches
Often FH/PH of migraines
3
Q
Abdominal Migraine:
Treatment
A
Pizotifen
4
Q
The 90%: Definition
A
- Pain central, around umbilicus
Otherwise entirely well
5
Q
The 90%:
Due to:
A
- Psychological
Cycle: Anxiety and escalation leading to pain, create family distress, demads for investigation, more anxiety.
6
Q
The 90%:
Some have
A
- IBS
- Non-ulcer dyspepsia
- Abdo migraine
7
Q
IBS:
Definition
A
Altered GI motility and an abnormal sensation of intra-abdominal events – Abnormally forceful contractions occur
Related to psychosocial factors e.g. stress and anxiety.
8
Q
IBS:
RF
A
+ve FH
9
Q
IBS:
S&S
A
- Abdo pain – worse before or relieved by defeacation
- Mucousy stools
- Bloating
- Feeling of incomplete defecation
Constipation – Alternating with normal/loose stools
10
Q
Non-Ulcer Dyspepsia: S&S
A
Suggesting Upper GI disorder - Epigastric pain - Postprandial vomiting - Belching - Bloating - Early satiety Heartburn
11
Q
Non-Ulcer Dyspepsia:
Investigations
A
Endoscopy (gastric motility abnormal – fails to reveal ulcer/mucosal disease)
12
Q
Management of Recurrent Abdo pain:
A
- Full history and examination
o Establish child is growing normally and no abnormalities
o Must be seen to be doing something - Urine microscopy and culture for possible UTI
13
Q
Prognosis:
A
- ½ rapidly become free of symptoms.
- ¼ symptoms take some months to resolve.
- ¼ symptoms continue to return in adulthood as IBS, non-ulcer dyspepsia or cranial migraine.
