abdo pain and constipation in children Flashcards
(18 cards)
what are medical causes of abdominal pain?
- constipation
- UTI
- coeliac
- IBD
- IBS
- mesenteric adenitis
- HSP
- Tonsilitis
- Infantile colic
what are causes of abdominal pain specific to adolescent girls?
- dymenorrhoea
- mittleschmerz
- ectopic pregnancy
- PID
- ovarian torsion
- pregnancy
what are surgical causes of abdominal pain?
- appendicitis
- intususseption- redcurrent jelly stool- pain is colicky and non specific
- bowel obtstuction- pain, distention, absolute constipation and vomiting
- testicular torsion- unilateral with nausea and vomitting
what are some initial investigations for abdominal pain and what would they suggest?
Anaemia can indicate inflammatory bowel disease or coeliac disease
Raised inflammatory markers (ESR and CRP) can indicate inflammatory bowel disease
Raised anti-TTG or anti-EMA antibodies indicates coeliac disease
Raised faecal calprotectin indicates inflammatory bowel disease
Positive urine dipstick indicates a urinary tract infection
what is non functional abdominal pain?
- reccurrent abdominal pain without an identifiable cause
- often corresponds to stressful life events
what is the management for nonidentifiable addominal pain?
- careful explaination and reassurance
- distraction with other activities
- regular sleeping, meals and balanced diet
- avoid NSAIDS and ibuprofen
- school support
- address triggers
what are features of abdominal migraine?
young children may present like this first and then get migraines when they are older
central abdo pain>1 hour which may be associated with:
- N&V
- anorexia
- headache
- photophobia
- aura
how can an acute abdominal migraine attack be treated?
- low stimulus environement- quite dark room
- paracetamol
- ibuprofen
- sumatriptan
what are preventative medications for abdominal migraine?
- Pizotifen, a serotonin agonist (needs to be withdrawn slowly)
- Propranolol, a non-selective beta blocker
- Cyproheptadine, an antihistamine
- Flunarazine, a calcium channel blocker
what ar the side effects of withdrawing pizotifen quickly?
- depression
- anxiety
- poor sleep
- tremor
what is retentive posturing?
- if are constipated then will have straight legs, be on tip-toes with back arched
what is overflow soiling?
- incontinence with loose smelly stool s due to faecal impaction stretching the rectum
constipation can also lead to the loss of sensation of needing to open the bowels as they become desensitised over time
what is the term for faecal incontinence?
encopresis
when is faecal incontinence deemed pathological?
over age 4
what are other causes of encopresis apart form constipation?
Spina bifida Hirschprung’s disease Cerebral palsy Learning disability Psychosocial stress Abuse
what are red flags in a constipation history?
- Not passing meconium within 48 hours of birth (cystic fibrosis or Hirschsprung’s disease)
- Neurological signs or symptoms, particularly in the lower limbs (cerebral palsy or spinal cord lesion)
- Vomiting (intestinal obstruction or Hirschsprung’s disease)
- Ribbon stool (anal stenosis)
- Abnormal anus (anal stenosis, inflammatory bowel disease or sexual abuse)
- Abnormal lower back or buttocks (spina bifida, spinal cord lesion or sacral agenesis)
- Failure to thrive (coeliac disease,
- hypothyroidism or safeguarding)
- Acute severe abdominal pain and bloating (obstruction or intussusception)
what are lifestyle factors that influence constipation
Habitually not opening the bowels Low fibre diet Poor fluid intake and dehydration Sedentary lifestyle Psychosocial problems such as a difficult home or school environment (always keep safeguarding in mind)
how can constipation be managed?
- high fibre diet and good hydration
- movicol is first line- osmotic laxative …should not be given long term and should be weaned off
- disimpaction regimine if impacted (with high dose of laxatives first line)
- schedule visits to toilet and star charts
