W13_03 common problems in the older child

Question 1

define chronic abdominal pain

Answer 1

long-lasting intermittent or constant abdominal pain that is functional or organic

Question 2

what’s the rate of occurrence of abdominal pain?

Answer 2

common problem - 13-17% of children between 4-16

Question 3

what’s the 3 broad categories of Ddxing chronic abdominal pain?

Answer 3

organic GI disorders;
organic non-GI disorders;
functional GI disorders

Question 4

what are organic GI disorders?

Answer 4

anything that can go wrong in the organs involved with the GI tract

Question 5

what are organic non-GI disorders?

Answer 5

issues in other places that lead to abdo pain (e.g. pneumonia referred pain to diaphragm, and presenting as abdo pain)

Question 6

what are some red flags? (exam)

Answer 6

weight loss;
recurrent oral ulcers;
bilious emesis;
unexplained fevers;
nocturnal symptoms;
melena

Question 7

what are some red flags (2)? (exam)

Answer 7

hematochezia;
occult blood loss;
chronic unexplained diarrhea;
acute abdomen;
jaundice;
anal skin tags/fissures;
joint symptoms

Question 8

what are some red flags (3)? (exam)

Answer 8

dysuria,hematuria,flank pain;
fam Hx of GI disease;
dysphagia;
anemia, leukocytosis;
hypoalbuminemia;
unexplained rashes

Question 9

what are the ROME III criteria for functional GI disorders?

Answer 9

no evidence of inflammatory, metabolic, neoplastic processes;
IBS;
functional dyspepsia;
abdominal migraine;
functional abdominal pain;
functional abdominal pain SYNDROME

Question 10

where does functional abdominal pain typically present?

Answer 10

periumbilical

Question 11

what are some clinical features of functional abdominal pain?

Answer 11

periumbilical;
unrelated to meals/activities;
doesn’t wake child from sleep;
normal growth;
no findings on physical exam;
interferes with school+normal activities

Question 12

what are some proposed pathogenesis of functional abdominal pain?

Answer 12

psychological stressors;
visceral hyperalgesia

Question 13

what’s the management for functional abdominal pain?

Answer 13

education;
multi-disciplinary approach;
medical treatment for pain;
psychological treatment with cognitive behavioural therapy (CBT);
dietary modifications

Question 14

what kinds of foods to typically avoid for functional abdominal pain?

Answer 14

avoid irritating foods (tomato, citrus, caffeine, greasy, spicy);
tell parents to keep a food diary to distract them

Question 15

how do probiotics affect functional abdominal pain?

Answer 15

mechanisms unclear, but may be beneficial

Question 16

how to speak with parents about functional abdominal pain?

Answer 16

reassurance;
acknowledge the pain is real;
encourage continued activities and school attendance

Question 17

prognosis of functional abdominal pain?

Answer 17

many children improve with time;
about 1/3 will continue, and have more absences

Question 18

what are the four patterns of headaches?

Answer 18

acute;
acute recurrent;
chronic progressive;
chronic non-progressive

Question 19

what’s the DDx of episodic recurrent headaches?

Answer 19

tension headaches;
migraines;
fasting/eating disorders;
recurrent toxic exposures;
recurrent sinus disease;
seizure-associated

Question 20

what’s the DDx of chronic progressive headaches?

Answer 20

elevated ICP;
tumour;
vascular malformation;
infection;
sinus venous thrombosis;
vasculitis

Question 21

what are red flags for secondary headache?

Answer 21

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)

Question 22

note: there are other types of migraine syndromes

Answer 22

might cause a bunch of neurological symptoms like aphasia, vertigo, etc etc

Question 23

what’s the best test for a recurrent headache?

Answer 23

history + physical (neuroimaging not the first line choice)

Question 24

what’s the SMART headache management mnemonic?

Answer 24

sleep;
meals;
activity;
relaxation;
trigger avoidance

Question 25

when to give pain killers for a headache?

Answer 25

at onset

Question 26

note: recall rebound headaches

Answer 26

overuse of ibuprofen/acetaminophen