Abdominal Pain in Children
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Introduction
Chronic abdominal pain is at least one a week, for at least 2 months (Rome III definition)
Prevalence of 10-20% of all children. It occurs most commonly between 4-14, with peaks at 4-6 and 7-12.
females seem to be affected a little bit more.
The Case of...
Causes and Risk Factors
Causes:
functional: no specific metabolic, infectious, inflammaory or neoplastic casue can be found to explain the symtoms
5-10% organic, 90-95% functional
organic causes
- gastrointestinal: esophagitis, peptic ulcer, celiac disease, crohn's disease, constipation, lactose intolerance, bowel obstruction (malrotation, etc)
- genitourinary (infection, obstruction)
- hepatobiliary
- pancreatic
- others depression, etc
Pathophysiology
the brain-gut axis
the average adult has 100 million
people are not making it up
visceral hyperalgesia
enteric nervous system has 'gut feelings' ; some people have enhanced gut awareness
serotonin receptors found on afferent neurons
have altered threshold of gut wall receptors
altered modulation in conduction of sensory input
decreased threshold for pain perception at the cortical level
Signs and Symptoms
- history
- physical exam
History
nutritional history
school
family history
stressors
- how is the family structure? are siblings still together?
- has the family moved?
- how are the family finances
- is the child having difficulty with peers?
functional pain
characteristics:
may occur in clusters lasting weeks
severity ranges from mild to severe
once daily, or several times daily
peri-umbilical to mid-epigastric or diffuse
- appleby's law: the further from the umbilius, the more likely it is organic
non-radiating, with difficulty describing character of pian
no relationship to meals, rarely noctural
often affects activities
sporadic vomiting may occur
occasional mild diarrhea
certain personality types are more common
- overachievers, over-conscientious, high-strung, apprehensive, anxious, timid
- anxiety, depression more common
Physical Exam
Physical exam typically normal, with normal growth.
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
Cognitive-behavioural therapy (CBT) offered to children with functional abdomenal pain, and their parents, can result in significant reduction in pain, lasting up to six months (Levy et al, 2010).
Consequences and Course
Resources and References
Levy RL, et al. 2010. Cognitive behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. Am J Gastroenterol. 105(4):946-956.
Topic Development
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