Chronic Abdominal Pain
Definition
"Rule of 3's":
Epidemiology
Aetiology
Organic (<10%)
Functional/Recurrent Abdominal Pain (RAP) (90%)
Clinical Features
RAP
Investigations
Treatment
Prognosis
Source
Toronto Notes 2012
"Rule of 3's":
- 3 episodes of pain severe enough to affect activities, occurring in a child
- >3 yrs of age
- Over a period of 3 months
Epidemiology
- 10-15% of children
- School age, peak 8-10 yr
- Prevalence: 10% of school children, F> M
Aetiology
Organic (<10%)
- Gastrointestinal
- Constipation (cause vs. effect), infectious
- IBD, oesophagitis, peptic ulcer disease, lactose intolerance
- Anatomic anomalies, masses
- Pancreatic, hepatobiliary
- Genitourinary causes
- Recurrent urinary tract infections
- Nephrolithiasis
- Chronic PID
- Mittelschmerz
- Neoplastic
Functional/Recurrent Abdominal Pain (RAP) (90%)
Clinical Features
RAP
- Vague, crampy periumbilical or epigastric pain, vivid imagery to describe pain, clustering of episodes
- Aggravated by exercise, alleviated by rest
- Diagnosis by exclusion of organic disorders
Investigations
- FBC, ESR, urinalysis, stools for O&P, C&S, occult blood
Treatment
- Trial of high fibre diet, trial
- Lactose-free diet
- Reassurance
Prognosis
- Pain resolves in 30-50% of kids within 2-6 wks of diagnosis
- 30-50% of kids with RAP have functional pain as adults (e.g. irritable bowel syndrome)
Source
Toronto Notes 2012