Colic and Functional Abdominal Pain

Question 1

Explain what colic is when referring to infants?

Answer 1

In infants colic is the term given to the following symptom profile:

Paroxysmal, inconsolable crying often accompanied by drawing up the knees and passage of wind.

This may occur several times a day often the evening.

The cause is unknown.

Question 2

How common is colic and which age range is most susceptible?

Answer 2

It is very common occurring in ~40% of babies.

It often occurs in the first few weeks of life and usually resolves by 4 months of age.

Question 3

What advise should be given to a parent who’s child suffers from colic?

Answer 3

Go see the GP if you are worried.

It is often normal and likely to grow out of it.

If very severe/persistent seek GP as may be a cow’s milk intolerance in which case can trial specialised formula.

Question 4

What is functional abdominal pain?

Answer 4

Pain sufficient to interrupt normal activities which has been going on intermittently for at least 3 months.

It is thought to occur in unto 10% of school children.

Question 5

What symptoms are there in functional abdominal pain?

Answer 5

Peri-umbilical pain, otherwise the child is usually well.

Question 6

What is the potential aetiology of functional abdominal pain?

Answer 6

Cause only identified in 10% of children.

Theories regarding somatic manifestation of anxiety and stress.

Other theories that it is a presentation of:
-IBS

• Abdominal migraine (often associated with vomiting and pallor)
• Functional dyspepsia (symptoms of dyspepsia without changes to mucosa) also have symptoms of early satiety and bloating.

Question 7

What is the prognosis and aim of management of functional abdominal pain?

Answer 7

Essentially rule out any likely organic causes of illness and offer reassurance as:

50% have a relatively rapid recovery.
25% take several months to recover.
25% continue and are diagnosed as having: 
-IBS
-Abdominal migraines
-Functional dyspepsia

Question 8

What is mesenteric adenitis?

Answer 8

Inflammation of the mesenteric lymph glands in the abdomen.

Most likely caused by infection, usually viral.

Question 9

How does mesenteric adenitis present?

Answer 9

Can occur unto the age of 16 but it is less common as children get older.

It presents with:
• Pain in the abdomen usually centrally or in the right iliac fossa.
• Fever and generally unwell
• Nausea and/or diarrhoea

May have been a sore throat prior to this.

Question 10

What is the management of mesenteric adenitis?

Answer 10

Rule out other more dangerous differentials:

• Appendicitis
• Ectopic Pregnancy

Mesenteric adenines itself is self limiting therefore treatment is just supportive.