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4th Year Paediatrics > Abdominal pain > Flashcards

Abdominal pain Flashcards

1
Q

What are the categories of causes of abdominal pain?

A
  • Functional
  • Medical
  • Surgical
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2
Q

Describe functional abdominal pain

A

This is where no disease process can be found to explain the pain. It is very common in children over 5. Other causes need to be excluded before diagnosing functional pain.

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3
Q

Medical causes of abdominal pain in children

A
  • Constipation
  • Urinary tract infection
  • Coeliac disease
  • Inflammatory bowel disease
  • Irritable bowel syndrome
  • Mesenteric adenitis
  • Tonsilitis
  • Abdominal migraine
  • Pyelonephritis
  • Henoch-Schonlein purpura
  • Diabetic ketoacidosis
  • Infantile colic
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4
Q

Additional medical causes of abdominal pain in adolescent girls

A
  • Dysmenorrhea (period pain)
  • Mittelschmerz (ovulation pain)
  • Ectopic pregnancy
  • Pelvic inflammatory disease
  • Ovarian torsion
  • Pregnancy
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5
Q

Surgical casues of abdominal pain in children

A
  • Appendicitis causes central abdominal pain spreading to the right iliac fossa
  • Intussusception causes colicky non-specific abdominal pain with redcurrant jelly stools
  • Bowel obstruction causes pain, distention, absolute constipation and vomiting
  • Testicular torsion causes sudden onset, unilateral testicular pain, nausea and vomiting
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6
Q

Red flags for serious abdominal pain:

A
  • Dysphagia
  • ​Persistent or bilious vomiting
  • Abdominal tenderness
  • Severe chronic diarrhoea
  • Rectal bleeding
  • Weight loss or faltering growth
  • Fever
  • Nighttime pain
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7
Q

Which pathology could anaemia indicate?

A

Inflamatory bowel disease or coeliac disease

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8
Q

Which pathology could raised inflammatory markers indicate?

A

Inflammatory bowel disease

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9
Q

Which raised antibodies would indicate coeliac disease?

A

Raised anti-TTG or anti-EMA antibodies

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10
Q

What would raised foecal calprotectin indicate?

A

Inflammatory bowel disease

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11
Q

What is recurrent abdominal pain and what is the theroy of it’s cause?

A

Function pain which often corresponds to stressful life event such as loss of a relative or bullying.

The leading theory for the cause is increased sensitivity and inappropriate pain signals from the visceral nerves (the nerves in the gut) in response to normal stimuli.

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12
Q

Management of recurrent abdominal pain involves careful explanation and reassurance. Measures that can help manage the pain are:

A
  • Distracting the child from the pain with other activities or interests
  • Encourage parents not to ask about or focus on the pain
  • Advice about sleep, regular meals, healthy balanced diet, staying hydrated, exercise and reducing stress
  • Probiotic supplements may help symptoms of irritable bowel syndrome
  • Avoid NSAIDs such as ibuprofen
  • Address psychosocial triggers and exacerbating factors
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13
Q

Who develops abdominal migraines and how do they present?

A

This may occur in young children before they develop traditional migraines as they get older.

Abdominal migraine presents with episodes of central abdominal pain lasting more than 1 hour. Examination will be normal.

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14
Q

Abdominal migraine may be associated with which symptoms?

A
  • Headache
  • Photophobia
  • Aura
  • Nausea and vomiting
  • Anorexia
  • Pallor
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15
Q

How would an acute abdominal migraine attack be treated?

A
  • Low stimulus environment (quiet, dark room)
  • Paracetamol
  • Ibuprofen
  • Sumatriptan
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16
Q

Preventative medications for an abdominal migraine

A
  • Pizotifen a serotonin agonist (needs to be withdrawn slowly)
  • Propranolol a non-selective beta blocker
  • Cyproheptadine an antihistamine
  • Flunarazine a calcium channel blocker
17
Q

Pathology of coeliac disease

A

Autoantibodies are created in response to exposure to gluten. These autoantibodies target the epithelial cells of the intestine and lead to inflammation.

Inflammation affects the small bowel, particularly the jejunum. It causes atrophy of the intestinal villi. The inflammation causes malabsorption of nutrients and disease related symptoms.

18
Q

Possible symptoms of coeliac disease:

A
  • Failure to thrive in young children
  • Diarrhoea
  • Fatigue
  • Weight loss
  • Mouth ulcers
  • Anaemia secondary to iron, B12 or folate deficiency
  • Dermatitis herpetiformis is an itchy blistering skin rash that typically appears on the abdomen
19
Q

Rarely coeliac disease can present with neurologic symptoms:

A
  • Peripheral neuropathy
  • Cerebellar ataxia
  • Epilepsy
20
Q

Which group of patients should be tested for coeliac disease even though they have no symptoms?

A

Those with a new diagnosis of type 1 diabetes mellitus as the conditions are often linked.

21
Q

When testing for anti-TTG and anti-EMA anitibodies what else must you test for and why?

How else can coeliac disease be diagnosed?

A

Anti-TTG and anti-EMA antibodies are IgA. Some patients have an IgA deficiency. When you test for these antibodies, it is important to test for total Immunoglobulin A levels because if total IgA is low the coeliac test will be negative even when they have the condition.

In this circumstance you can test for the IgG version of the anti-TTG or anti-EMA antibodies or do an endoscopy with biopsies

22
Q

What must be remembered about patinets diet when investigating for coeliac disease?

A

They must be on a diet containing gluten

23
Q

Genetic associations for coeliac disease

A
  • HLA-DQ2 gene (90%)
  • HLA-DQ8 gene
24
Q

In coeliac disease what will an endoscopy and intestinal biopsy show?

A
  • “Crypt hypertrophy”
  • “Villous atrophy”
25
Q

Conditions associated with coeliac disease:

A
  • Type 1 diabetes
  • Thyroid disease
  • Autoimmune hepatitis
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Down’s syndrome
26
Q

Complications of untreated coeliac disease:

A
  • Vitamin deficiency
  • Anaemia
  • Osteoporosis
  • Ulcerative jejunitis
  • Enteropathy-associated T-cell lymphoma (EATL) of the intestine
  • Non-Hodgkin lymphoma (NHL)
  • Small bowel adenocarcinoma (rare)
27
Q

Treatment of coeliac disease

A

A lifelong gluten free diet

4th Year Paediatrics (6 decks)

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