Paeds: Recurrent abdo pain in children Flashcards Preview

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Flashcards in Paeds: Recurrent abdo pain in children Deck (13):
1

Differentials:

1. Abdominal Migraine
2. The 90%:
a. Psychological
b. Cycle: Anxiety and escalation leading to pain, create family distress, demands for investigation, more anxiety.
c. IBS
d. Non-ulcer dyspepsia
e. Abdo migraine
3. Gastritis and Peptic Ulceration

2

Abdominal Migraine:
Definition

- Cranial migraine often associated with abdo pain in addition to headaches
Often FH/PH of migraines

3

Abdominal Migraine:
Treatment

Pizotifen

4

The 90%: Definition

- Pain central, around umbilicus
Otherwise entirely well

5

The 90%:
Due to:

- Psychological
Cycle: Anxiety and escalation leading to pain, create family distress, demads for investigation, more anxiety.

6

The 90%:
Some have

- IBS
- Non-ulcer dyspepsia
- Abdo migraine

7

IBS:
Definition

Altered GI motility and an abnormal sensation of intra-abdominal events – Abnormally forceful contractions occur
Related to psychosocial factors e.g. stress and anxiety.

8

IBS:
RF

+ve FH

9

IBS:
S&S

- Abdo pain – worse before or relieved by defeacation
- Mucousy stools
- Bloating
- Feeling of incomplete defecation
Constipation – Alternating with normal/loose stools

10

Non-Ulcer Dyspepsia: S&S

Suggesting Upper GI disorder
- Epigastric pain
- Postprandial vomiting
- Belching
- Bloating
- Early satiety
Heartburn

11

Non-Ulcer Dyspepsia:
Investigations

Endoscopy (gastric motility abnormal – fails to reveal ulcer/mucosal disease)

12

Management of Recurrent Abdo pain:

- Full history and examination
o Establish child is growing normally and no abnormalities
o Must be seen to be doing something
- Urine microscopy and culture for possible UTI

13

Prognosis:

1. ½ rapidly become free of symptoms.
2. ¼ symptoms take some months to resolve.
3. ¼ symptoms continue to return in adulthood as IBS, non-ulcer dyspepsia or cranial migraine.

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