W13_03 common problems in the older child Flashcards
define chronic abdominal pain
long-lasting intermittent or constant abdominal pain that is functional or organic
what’s the rate of occurrence of abdominal pain?
common problem - 13-17% of children between 4-16
what’s the 3 broad categories of Ddxing chronic abdominal pain?
organic GI disorders;
organic non-GI disorders;
functional GI disorders
what are organic GI disorders?
anything that can go wrong in the organs involved with the GI tract
what are organic non-GI disorders?
issues in other places that lead to abdo pain (e.g. pneumonia referred pain to diaphragm, and presenting as abdo pain)
what are some red flags? (exam)
weight loss;
recurrent oral ulcers;
bilious emesis;
unexplained fevers;
nocturnal symptoms;
melena
what are some red flags (2)? (exam)
hematochezia;
occult blood loss;
chronic unexplained diarrhea;
acute abdomen;
jaundice;
anal skin tags/fissures;
joint symptoms
what are some red flags (3)? (exam)
dysuria,hematuria,flank pain;
fam Hx of GI disease;
dysphagia;
anemia, leukocytosis;
hypoalbuminemia;
unexplained rashes
what are the ROME III criteria for functional GI disorders?
no evidence of inflammatory, metabolic, neoplastic processes;
IBS;
functional dyspepsia;
abdominal migraine;
functional abdominal pain;
functional abdominal pain SYNDROME
where does functional abdominal pain typically present?
periumbilical
what are some clinical features of functional abdominal pain?
periumbilical;
unrelated to meals/activities;
doesn’t wake child from sleep;
normal growth;
no findings on physical exam;
interferes with school+normal activities
what are some proposed pathogenesis of functional abdominal pain?
psychological stressors;
visceral hyperalgesia
what’s the management for functional abdominal pain?
education;
multi-disciplinary approach;
medical treatment for pain;
psychological treatment with cognitive behavioural therapy (CBT);
dietary modifications
what kinds of foods to typically avoid for functional abdominal pain?
avoid irritating foods (tomato, citrus, caffeine, greasy, spicy);
tell parents to keep a food diary to distract them
how do probiotics affect functional abdominal pain?
mechanisms unclear, but may be beneficial
how to speak with parents about functional abdominal pain?
reassurance;
acknowledge the pain is real;
encourage continued activities and school attendance
prognosis of functional abdominal pain?
many children improve with time;
about 1/3 will continue, and have more absences
what are the four patterns of headaches?
acute;
acute recurrent;
chronic progressive;
chronic non-progressive
what’s the DDx of episodic recurrent headaches?
tension headaches;
migraines;
fasting/eating disorders;
recurrent toxic exposures;
recurrent sinus disease;
seizure-associated
what’s the DDx of chronic progressive headaches?
elevated ICP;
tumour;
vascular malformation;
infection;
sinus venous thrombosis;
vasculitis
what are red flags for secondary headache?
younger than 3 years;
progressive pattern;
increased headache with valsalva;
“thunderclap” headache;
systemic symptoms of cancer;
immunosuppression, hypercoagulable state, cancer, neurocutaneous disoder;
neurologic symptoms like altered mental status;
new/different severe headache;
sleep-related (wakes child at night or still present in the morning)
note: there are other types of migraine syndromes
might cause a bunch of neurological symptoms like aphasia, vertigo, etc etc
what’s the best test for a recurrent headache?
history + physical (neuroimaging not the first line choice)
what’s the SMART headache management mnemonic?
sleep;
meals;
activity;
relaxation;
trigger avoidance
when to give pain killers for a headache?
at onset
note: recall rebound headaches
overuse of ibuprofen/acetaminophen
