Chronic Abdominal pain Flashcards Preview

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Flashcards in Chronic Abdominal pain Deck (23):
1

Qualities of pain

P - position
Q - quality
R - radiation
S - severity
T - timing
A - alleviating
A - aggravating
A - associated sx

2

Functional abdominal pain

most common cause of abdominal pain in school-aged kids
- functional dyspepsia, abdominal migraine, irritable bowel
Diagnosis
- if no alarming symptoms, PE normal, stool sample negative

3

Ab pain in kids DON'T MISS

weight loss
decrease in growth
GI blood loss
vomiting
severe diarrhea
RUQ or RLQ recurrent pain
Unexplained fever
Fam Hx of inflammatory bowel disease

4

Growth charts

important to plot the data points otherwise you may miss things

5

Rectal Exams

perform if suspect:
- GI bleed
- intussusception
- rectal abscess
- impaction

6

DDx for ab pain with bloody stools

Inflammatory bowel disease
Celiac disease
Bacterial Gastroenteritis
Giardiasis
Peptic Ulcer Disease
Henoch-Scholein Purpura

7

IBD

severe, moderate, mild abdominal pain
- bloody stools are suggestive of IBD

8

Celiac

children typically present 6-24 months with chronic abdominal pain, distention, diarrhea, anorexia, vomiting
- variable presentation

9

Bacterial Gastroenteritis

Salmonella, shigella, campylobacter --> frequent causes of bloody diarrhea
C. diff another possible cause
- could have possible underlying colitis

10

Giardiasis

parasite --> causes chronic abdominal pain
TRAVEL HISTORY
- can cause bloody stools but not as likely

11

Peptic Ulcer Disease

relatively uncommon in kids but can cause bloody stools
- should be on differential

12

Henoch-Schonlein Purpura

abdominal pain develops within days of rash
- half have (+) guaiac stool tests

13

Labs for abdominal pain and bloody stools

CBC w/ diff - check for anemia
ESR - nonspecific for inflammation
Hepatic profile - malnutrition
IgA TTA - check for celiac disease (sens and spec)
Stool ova and parasite - especially with chronic sx
Stool culture - important to check if chronic symptoms and bloody stool

14

Anemia classification

Microcytic - iron deficiency --> low iron, high binding capacity
Normocytic - inflammation/infection causes decreased production of RBCs or lead poisoning

15

Red Flag's of Crohn's Disease

pain waking child up, localized pain, involuntary weight loss
extraintestinal symptoms, (+) FamHx, abnormal bowel function

16

Ulcerative Colitis

- relatively generalized inflammation to mucosa --> starting at rectum and advancing proximally
- crypt abscesses
- inflammation becomes more confluent

17

Crohn's Disease

- inflammation sporadic and can involve any part of alimentary tract
- patchy inflammation that can involve submucosa, muscularis or serosa
- transmural inflammation --> fistula

18

Definitive diagnosis of UC or CD

combo of radiography and endoscopy
- upper endoscopy and colonoscopy

19

Grading Crohn's

# of diarrhea stools per day
daily abdominal pain
presence of symptoms
abdominal fullness
hematocrit
height and weight

20

Etiology of IBD

typically presents in 3rd decade of life
25-30% in 2nd decade
5% before 10 years old
*most progress to relapsing/chronic disease

21

Treating Crohn's disease

Immunomodulators has become standard of care for children
- mild presentation --> aminosalicylate (1st line)
- corticosteroids are great at reducing inflammation and inducing remission

22

Genetic Risk Factors for Crohn's

Single greatest risk factor --> 1st degree relative with it
- there have been genes identified

23

Extraintestinal manifestations of Crohn's

arthritis
uveitis
renal involvement (kidney stones)
hepatic involvement
erythema nodosum