Abdominal pain in children Flashcards
(18 cards)
How can abdominal pain in children be categorised?
Non organic causes, medical causes and surgical causes.
What is non organic/functional abdominal pain?
Very common in children > 5 years; no disease process can be found to explain the pain.
What are some causes that need to be excluded before diagnosing non-organic pain?
- constipation is very common
- UTI
- coeliac disease
- inflammatory bowel disease
- IBS
- mesenteric adenitis
- abdominal migraine
- pyelonephritis
- Henoch-Schonlein purpura
- tonsilitis
- diabetic ketoacidosis
- infantile colic
What are some additional causes of abdominal pain in adolescent girls?
- dysmenorrhoea
- mittelschmerz (ovulation pain)
- ectopic pregnancy
- PID
- ovarian torsion
- pregnancy
What are surgical causes of abdominal pain?
- appendicitis: central abdominal pain, spreading to RIF
- intussusception: colicky non specific abdominal pain with redcurrant jelly stools
- bowel obstruction: pain, distension, absolute constipation and vomiting
- testicular torsion: sudden onset, unilateral testicular pain, nausea and vomiting
What are red flags for serious abdominal pain?
- persistent or bilious vomiting
- severe chronic diarrhoea
- fever
- rectal bleeding
- weight loss or faltering growth
- dysphagia (difficulty swallowing)
- night time pain
- abdominal tenderness
What initial investigations may indicate pathology?
- anaemia: can indicate IBD or coeliac disease
- raised inflammatory markers (ESR and CRP) and indicate IBD
- raised anti-TTG or anti-EMA antibodies indicates coeliac disease
- raised faecal calprotectin indicates IBD
- positive urine dipstick indicated UTI
When is a diagnosis of recurrent abdominal pain made?
When a child presents with repeated episodes of abdominal pain without an identifiable underlying cause; the pain is described as non organic or functional.
What other diagnoses overlap with recurrent abdominal pain?
Abdominal migraine, IBS, functional abdominal pain.
When can recurrent abdominal pain correspond to?
Stressful life events, e.g., loss of a relative or bullying.
What is the management for recurrent abdominal pain?
- careful explanation and reassurance
- 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 IBS
- avoid NSAIDs eg. ibuprofen
- address psychosocial triggers and exacerbating factors
- support from a school counsellor or child psychologist
When can abdominal migraine develop?
More likely to occur in children than adults; can occur in young children before they develop traditional migraines as they get older.
How does abdominal migraine present?
In young children with episodes of central abdominal pain lasting more than 1 hour; examination will be normal.
What other symptoms may be associated with abdominal migraine?
- nausea and vomiting
- anorexia
- pallor
- headache
- photophobia
- aura
What is the management for abdominal migraine?
Similar management to migraine in adults; careful explanation and education; treating acute attacks and preventative measures.
How to treat the acute attack of abdominal migraine?
Low stimulus environment (quiet, dark room), paracetamol, ibuprofen, sumatriptan.
What are preventative medications for abdominal migraine?
- Pizotifen = serotonin antagonist → main preventative medication
- Propanolol = beta blocker
- Cyproheptadine = antihistamine
- Flunarazine = CCB
What can Pizotifen be associated with?
Withdrawal symptoms such as depression, anxiety, poor sleep and tremor; therefore needs to be withdrawn slowly when stopping it.
