Acute Abdominal Pain

Question 1

How would you define recurrent abdominal pain in childhood?

Answer 1

At least one episode per month for at least 3 consecutive months
The pain must be severe enough to interfere with routine functioning

Question 2

What are the red flag features that would prompt further investigation in child with recurrent abdominal pain?

Answer 2

1. Age <5
2. Systemic features; weight loss, recurrent oral ulcers, fever, dysphagia, vomiting (haematemesis, bilious)
3. Nocturnal symptoms - waking child from sleep (differentiate between waking from sleep and preventing from getting to sleep)
4. Persistent right upper or right lower abdominal pain
5. Dysuria/flank pain/haematuria
6. Chronic NSAID use
7. FHx IBD/peptic ulcer disease

Question 3

What are the red flag features on examination that would prompt further investigation in child with recurrent abdominal pain?

Answer 3

• Growth deceleration
• Delayed puberty
• Jaundice
• Pallor
• Rebound/guarding/organomegaly
• Perianal disease
• Blood in stool

Question 4

What are the red flag features on investigation that would prompt further investigation in child with recurrent abdominal pain?

Answer 4

• Raised WCC
• Raised inflammatory markers
• Anaemia, hypoalbuminaemia

Question 5

What are the common causes of malaena in children?

Answer 5

• Infective; bacterial (campylobacter, salmonella)
• IBD
• Torn anal vein
• Polyp
• Intussusception

Question 6

What investigations would you carry out for a patient with suspected IBD?

Answer 6

1. Bloods- FBC, U&E, LFT, CRP, ESR, Hb, WCC, Plt, Coagulation screen
2. Coeliac screening (IgA anti-tissue transglutaminase)
3. Stool- MC&S and calprotectin

Question 7

What imaging investigations may be required for patients with suspected IBD?

Answer 7

OGD
Colonoscopy
Barium study