W13_03 common problems in the older child Flashcards Preview

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Flashcards in W13_03 common problems in the older child Deck (26):
1

define chronic abdominal pain

long-lasting intermittent or constant abdominal pain that is functional or organic

2

what's the rate of occurrence of abdominal pain?

common problem - 13-17% of children between 4-16

3

what's the 3 broad categories of Ddxing chronic abdominal pain?

organic GI disorders;
organic non-GI disorders;
functional GI disorders

4

what are organic GI disorders?

anything that can go wrong in the organs involved with the GI tract

5

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)

6

what are some red flags? (exam)

weight loss;
recurrent oral ulcers;
bilious emesis;
unexplained fevers;
nocturnal symptoms;
melena

7

what are some red flags (2)? (exam)

hematochezia;
occult blood loss;
chronic unexplained diarrhea;
acute abdomen;
jaundice;
anal skin tags/fissures;
joint symptoms

8

what are some red flags (3)? (exam)

dysuria,hematuria,flank pain;
fam Hx of GI disease;
dysphagia;
anemia, leukocytosis;
hypoalbuminemia;
unexplained rashes

9

what are the ROME III criteria for functional GI disorders?

no evidence of inflammatory, metabolic, neoplastic processes;
IBS;
functional dyspepsia;
abdominal migraine;
functional abdominal pain;
functional abdominal pain SYNDROME

10

where does functional abdominal pain typically present?

periumbilical

11

what are some clinical features of functional abdominal pain?

periumbilical;
unrelated to meals/activities;
doesn't wake child from sleep;
normal growth;
no findings on physical exam;
interferes with school+normal activities

12

what are some proposed pathogenesis of functional abdominal pain?

psychological stressors;
visceral hyperalgesia

13

what's the management for functional abdominal pain?

education;
multi-disciplinary approach;
medical treatment for pain;
psychological treatment with cognitive behavioural therapy (CBT);
dietary modifications

14

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

15

how do probiotics affect functional abdominal pain?

mechanisms unclear, but may be beneficial

16

how to speak with parents about functional abdominal pain?

reassurance;
acknowledge the pain is real;
encourage continued activities and school attendance

17

prognosis of functional abdominal pain?

many children improve with time;
about 1/3 will continue, and have more absences

18

what are the four patterns of headaches?

acute;
acute recurrent;
chronic progressive;
chronic non-progressive

19

what's the DDx of episodic recurrent headaches?

tension headaches;
migraines;
fasting/eating disorders;
recurrent toxic exposures;
recurrent sinus disease;
seizure-associated

20

what's the DDx of chronic progressive headaches?

elevated ICP;
tumour;
vascular malformation;
infection;
sinus venous thrombosis;
vasculitis

21

what are red flags for secondary headache?

younger than 3 years;
progressive pattern;
increased headache with valsalva;
"thunderclap" headache;
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)

22

note: there are other types of migraine syndromes

might cause a bunch of neurological symptoms like aphasia, vertigo, etc etc

23

what's the best test for a recurrent headache?

history + physical (neuroimaging not the first line choice)

24

what's the SMART headache management mnemonic?

sleep;
meals;
activity;
relaxation;
trigger avoidance

25

when to give pain killers for a headache?

at onset

26

note: recall rebound headaches

overuse of ibuprofen/acetaminophen

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