Flashcards in W13_03 common problems in the older child Deck (26)
define chronic abdominal pain
long-lasting intermittent or constant abdominal pain that is functional or organic
what's the rate of occurrence of abdominal pain?
common problem - 13-17% of children between 4-16
what's the 3 broad categories of Ddxing chronic abdominal pain?
organic GI disorders;
organic non-GI disorders;
functional GI disorders
what are organic GI disorders?
anything that can go wrong in the organs involved with the GI tract
what are organic non-GI disorders?
issues in other places that lead to abdo pain (e.g. pneumonia referred pain to diaphragm, and presenting as abdo pain)
what are some red flags? (exam)
recurrent oral ulcers;
what are some red flags (2)? (exam)
occult blood loss;
chronic unexplained diarrhea;
anal skin tags/fissures;
what are some red flags (3)? (exam)
fam Hx of GI disease;
what are the ROME III criteria for functional GI disorders?
no evidence of inflammatory, metabolic, neoplastic processes;
functional abdominal pain;
functional abdominal pain SYNDROME
where does functional abdominal pain typically present?
what are some clinical features of functional abdominal pain?
unrelated to meals/activities;
doesn't wake child from sleep;
no findings on physical exam;
interferes with school+normal activities
what are some proposed pathogenesis of functional abdominal pain?
what's the management for functional abdominal pain?
medical treatment for pain;
psychological treatment with cognitive behavioural therapy (CBT);
what kinds of foods to typically avoid for functional abdominal pain?
avoid irritating foods (tomato, citrus, caffeine, greasy, spicy);
tell parents to keep a food diary to distract them
how do probiotics affect functional abdominal pain?
mechanisms unclear, but may be beneficial
how to speak with parents about functional abdominal pain?
acknowledge the pain is real;
encourage continued activities and school attendance
prognosis of functional abdominal pain?
many children improve with time;
about 1/3 will continue, and have more absences
what are the four patterns of headaches?
what's the DDx of episodic recurrent headaches?
recurrent toxic exposures;
recurrent sinus disease;
what's the DDx of chronic progressive headaches?
sinus venous thrombosis;
what are red flags for secondary headache?
younger than 3 years;
increased headache with valsalva;
systemic symptoms of cancer;
immunosuppression, hypercoagulable state, cancer, neurocutaneous disoder;
neurologic symptoms like altered mental status;
new/different severe headache;
sleep-related (wakes child at night or still present in the morning)
note: there are other types of migraine syndromes
might cause a bunch of neurological symptoms like aphasia, vertigo, etc etc
what's the best test for a recurrent headache?
history + physical (neuroimaging not the first line choice)
what's the SMART headache management mnemonic?
when to give pain killers for a headache?