Recurrent abdominal pain

definition
1. pain sufficient to interrupt normal activities
2. duration
  1. at least 3 months
may become part of a vicious cycle of anxiety
1. w/ escalating pain
2. anxiety may -> altered bowel motility
  1. child may perceive this as pain
epidemiology
1. 10% of school age kids
characteristically umbilical
child otherwise well
can be a manifestation of stress
3 distinct sx constellations arising from functional abnormalities of gut motility or enteral neurones
1. irritable bowel syndrome
  1. most common
2. abdominal migraine
3. functional dyspepsia
4. many ppl will have one of these 3
Mx
1. aim: ID any serious cause w/o unnecessary ix
2. o/e
  1. inspect perineum
    1. for anal fissures
3. urine microscopy and culture
4. abdominal ultrasound
  1. to exclude gall stones and pelvic ureteric junction obstruction
long-term prognosis
1. about 1/2 of affected children rapidly become free of sx
2. in 1/4, sx take some months to resolve
3. in 1/4, sx continue or return in adulthood as migraine, IBS or functional dyspepsia
cause
1. > 90% no structural cause IDed
2. gastrointestinal
  1. irritable bowel syndrome
  2. constipation
  3. non-ulcer dyspepsia
  4. abdominal migraine
  5. gastritis and peptic ulceration
    1. epigastric pain @ night, haematemesis (duodenal ulcer)
  6. inflammatory bowel disease
    1. diarrhoea
    2. weight loss
    3. blood in stools
  7. malrotation
    1. bilious vomiting
    2. abdo distension
3. gynaecological
  1. dysmenorrhoea
  2. ovarian cysts
  3. pelvic inflammatory disease
4. psychosocial
  1. bullying
  2. abuse
  3. stress
5. hepatobility/pancreatic
  1. hepatitis
    1. jaundice (liver disease)
  2. gallstones
  3. pancreatitis
    1. vomiting
6. urinary tract
  1. UTI
    1. dysuria
    2. secondary enuresis
  2. pelvi-ureteric junction obstruction

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Recurrent abdominal pain

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	Created by v.djabatey almost 11 years ago