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CHRONIC ABDOMINAL PAIN

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  1. 10-15% of children 
  2. definition: three or more episodes of pain severe enough to affect
    activities, occurring over a period of 3 months

Assessment

 

 

distinguish organic from non organic

 

History

  1. weight loss, appetite, energy
  2. associated vomiting, diarrhea
  3. characteristics of pain
  4. psychosocial issues 

 

physical exam: abnormalities suggest organic nature 

 

Red flags for organic etiology

  1. age < 5 years old                     
  2. fever
  3. pain away from midline         
  4. anemia
  5. localized pain awakens child at night   
  6. travel history
  7. prominent vomiting, diarrhea  
  8. weight loss or failure to
  9. joint paingain weight

Organic (< 10%)

 

  1. chronic infection
  2. GI
    • constipation - cause or effect?
    • inflammatory bowel disease
    • anatomic anomalies, masses
    • esophagitis
    • peptic ulcer disease, lactose intolerance
    • pancreatic, hepatobiliary 
  3. genitourinary disease 
  4. gynecological
  5. cardiovascular 
  6. neoplastic

 

Functional, Recurrent Abdominal Pain (RAP) (90%) 

 

  1. school age, peak 8-10 years 
  2. F > M
  3. vague, crampy periumbilical or epigastric pain, vivid imagery to
    describe pain 
  4. should not awaken child 
  5. no precipitating or relieving factors, no consistent pattern 
  6. child appears well with normal growth 
  7. associated with school absenteeism

Diagnosis

  1. must consider kidney disease, malrotation of bowel, IBD
  2. school phobia?

 

Investigations

 

  1. as indicated
  2. CBC, ESR, urinalysis, stools for O&P, C&S, occult blood

 

Treatment

  1. manage any emotional or family problems
  2. trial of high fibre diet, trial of lactose-free diet
  3. reassurance
CHRONIC ABDOMINAL PAIN CHRONIC ABDOMINAL PAIN Reviewed by Radiology Madeeasy on August 27, 2010 Rating: 5
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