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Its A Gut Feeling: Abdominal Pain in Children PowerPoint Presentation

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Published on : Aug 03, 2021 | Views : 1273 | Downloads : 1

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Slide 1-

It’s A Gut Feeling: Abdominal Pain in Children David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians
Slide 2-

Introduction Common Symptom Affects 10-15% of school-aged children Definition (Dr. John Apley) 3 episodes of pain over 3 months Interferes with normal daily activities Any child that seeks medical attention
Slide 3-

Causes Functional abdominal pain 90% of children Organic 10% of children How to tell if serious? Parents want an answer How much testing to do
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Functional Abdominal Pain No treatable cause found Irritable bowel syndrome Hypersensitivity disorder Visceral hyperalgia Not wimpy kids
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Symptoms of Functional Pain Age greater than 5 years-old Pain-free periods Periumbilical pain No relationship to eating, stools, stress, etc Headaches, dizziness, appear pale
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Symptoms of Functional Pain Fatigue or weakness Pains in arms and legs School absence but good student Pain interfering with activities out of proportion to evaluation Often a history of colic or feeding problems No red flags
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Red flags Suggesting Serious Problem Age less than 5 years-old Weight loss or poor growth Pain away from the belly button Vomiting Night-time pain
Slide 8-

Red flags Suggesting Serious Problem Diarrhea (night-time) Blood in the stool Fever Rash or joint pain Family history of ulcers, inflammatory bowel disease No school absenteeism
Slide 9-

Screening Tests Thorough history (without parents) Physical exam including growth chart Stool for blood CBC ESR UA Celiac screen Missed disease rare
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Treatment Avoid excessive tests Explanation of RAP Not faking it Similar to headache Encourage regular routine School attendance Adequate sleep
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Treatment High fiber diet Peppermint Healthy diet Fast food Caffeine Spicy foods Identify any stressors
Slide 12-

Stressful Stimuli Physical Stress Recent physical illness Milk intolerance Constipation
Slide 13-

Stressful Stimuli, cont. Emotional Stress Illness in family member School problems Recent move
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Treatment Counseling Treat anxiety Help family promote adaptive behaviors Children very suggestible Coping mechanisms Medications Antispasmodics Amitriptyline
Slide 15-

Prognosis One-third resolve within few months One-third replace abdominal pain with new symptom One-third continue with pain
Slide 16-

Common Causes School avoidance Constipation/Encopresis Muscle pain Urinary Tract Infection Physical or sexual abuse Food allergies Parasites Giardia, Blastocystis
Slide 17-

Common Causes, cont. Lactose Intolerance Onset 4-6 years-old Bloating, diarrhea, gas Breath test or dietary exclusion Carbohydrate Intolerance Fructose (fruit and juice, soft drinks) Sorbitol (fruits, sugar-free candy and gum)
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Common Causes, cont. Irritable bowel syndrome Abnormal contractions or sensation of the intestine Not a psychological illness Non-ulcer dyspepsia Diarrhea-predominant Constipation-predominant
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Common Causes, cont. Irritable bowel syndrome Rome criteria Pain relieved by stools Altered stools at time of pain Altered stool frequency at time of pain Mucus in stools Bloating
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Common Causes, cont. Irritable bowel syndrome treatment Probiotics Chamomile or peppermint tea Peppermint Relaxation techniques Medications Antispasmodics Amitriptyline
Slide 21-

Common Causes, cont. Gastroesophageal reflux History of spitting up as a baby Heartburn or regurgitation Epigastric or chest pain Dysphagia Treatment Maalox or Mylanta Acid suppression
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Common Causes, cont. Eosinophilic Esophagitis Reflux symptoms Dysphagia Related to food allergies Treatment Elimination diet Inhaled steroids
Slide 23-

Ulcers Somewhat rare Night-time pain, vomiting Etiology Ibuprofen Helicobacter pylori 20% of children Blood test, stool test, EGD
Slide 24-

Gallstones Rare Think if blood disorders, obesity, OCP’s Symptoms Upper abdominal pain after meals Increasing pain lasting 1-4 hours Associated with vomiting
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Inflammatory Bowel Disease 25% of patients less than 18 years-old Family history in 30% Autoimmune disease Ulcerative colitis Diarrhea, urgency, blood or mucus Crohn’s disease Weight loss, pain, diarrhea
Slide 26-

Celiac disease Common (1:100-200 people) Gluten (wheat, rye, barley) Variable symptoms Screen with antibody tests Diagnose with EGD Gluten-free diet for life
Slide 27-

Cyclic Vomiting Syndrome Migraine Equivalent Recurrent episodes of pain and vomiting Seasonal Diagnosis of exclusion Treatment Abortive therapy (Zofran, NSAIDs) Preventative