Paediatric Abdominal Pain

Information about Paediatric Abdominal Pain

Published on December 21, 2009

Author: samarsen

Source: authorstream.com

Content

RECURRENT ABDOMINAL PAIN : RECURRENT ABDOMINAL PAIN Dr S Sen Specialist Registrar Paediatrics Birch Hill Hospital Rochdale UK Outline : Outline Case presentation Introduction to recurrent abdominal pain Evaluation of recurrent abdominal pain Organic causes of recurrent abdominal pain Literature on management of recurrent abdominal pain Case presentation : Miss S 12 year old female Presented 15/08/02 Vomiting Abdominal pain - right sided and right loin No urinary symptoms Regular bowel motions 0.5stone weight loss in 6 mths Case presentation Past medical history : Past medical history 10/07/02-11/07/02 - ?UTI/appendicitis/appendix abscess US abd : bilateral mild renal pelvis dilatation;no RIF mass Review by general surgeons - nad Past medical history : Past medical history 1/08/02-2/08/02 - ?midcycle pain/appendix abscess Review by general surgeons - non-specific abdominal pain Prescribed lactulose ? constipation Past medical history : Past medical history 5/08/02-6/08/02 - ?renal colic/PID/menstrual pain/abdominal migraine/psychogenic Discussed with gynaecologists - unlikely to be pelvic inflammatory disease Social history : Social history Lives with mother 29 and father 34 Recently seeing friends less than usual Frequently sent home from school last 6mths - attends Don Valley High school Missed exams through illness Currently on school holidays Family history : Family history Paternal grandmother - bowel resection for Crohns disease Grandfather - renal calculi/cholelithiasis Physical examination : Physical examination Well No anaemia/jaundice No dehydration Apyrexial CVS/Resp/CNS - normal GI - tender RIF and right loin - no guarding/rebound - bowel sounds normal? fullness RIF Problem list : Problem list 1. Recurrent abdominal pain 2. Poor school attendence Differential diagnoses : Differential diagnoses Urinary tract infection Inflammatory bowel disease Management : Management Urine culture - nad Abdominal US - nad FBC, U+Es and LFTs - nad Referral sent to Sam Hawsworth (Springwood liason nurse) and patient discharged Introduction to recurrent abdominal pain : Introduction to recurrent abdominal pain Common : affects 10-20% of school children Primarily older children and adolescents ‘recurrent and moderately severe episodes of abdominal pain over a period of at least 3 mths, which may lead to absence from school and may affect the child’s lifestyle’ Introduction to recurrent abdominal pain : Introduction to recurrent abdominal pain Often non-specific pain : often colicky, periumbilical discomfort Healthy between episodes Physical examination normal Majority require careful history and examination only Introduction to recurrent abdominal pain : Introduction to recurrent abdominal pain Organic cause found in only 7% If no organic cause found, consider psychological disturbance / family dysfunction Slide 16:  Evaluation of recurrent abdominal pain : Evaluation of recurrent abdominal pain Use history, examination and minimal investigations Urine dipstick in all patients Periodicity of complaints, absence of other symptoms and intervening good health make non-organic cause more likely Evaluation of recurrent abdominal pain : Evaluation of recurrent abdominal pain Further investigation required if vomiting,diarrhoea, fever, weight loss and urinary symptoms Personality of child important : highly strung, anxious, timid, apprehensive - more likely to have problems with abdominal pain Organic causes of recurrent abdominal pain- Migraine : Organic causes of recurrent abdominal pain- Migraine Midline abdominal pain Associated with nausea and vasomotor symptoms Positive family history Renal tract causes : UTI/renal calculi/hydronephrosis : Renal tract causes : UTI/renal calculi/hydronephrosis UTI - Urinary symptoms - irritability,fever, vomiting, diarrhoea Loin pain with negative urine - consider hydronephrosis and do renal ultrasound Peptic ulceration : Peptic ulceration Sleep disturbance due to epigastric pain Positive family history Nausea and vomiting Haematemesis and melaena Iron-deficiency anaemia May need upper GI endoscopy Consider Helicobacter pylori Reflux oesophagitis : Reflux oesophagitis Epigastric pain Associated with belching and vomiting Diagnose by upper GI endoscopy and oesophageal pH studies Constipation : Constipation Passage of infrequent hard stools Stool consistency and frequency very important from history Stools maybe palpable on abdominal examination Inflammatory bowel disease - Crohns disease : Inflammatory bowel disease - Crohns disease Uncommon in children Can be insidious with subtle signs and symptoms Abd examination can show localised or generalised tenderness, and occasionally an ill-defined mass Common symptoms: Periumbilical colicky abd pain, diarrhoea, growth failure Crohns disease : Crohns disease More subtle presentations : Oropharyngeal disease,perianal skin tags and fissures Growth retardation and pubertal delay in up to 30% of children with Crohns disease Anaemia,raised CRP,raised ESR, raised platelets, low albumin, low zinc and abn LFTs Upper GIendoscopy, ileoscopy,colonoscopy Thank you : Thank you

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