Recurrent abdominal pain- abdo migraine, peptic ulceration, IBS

abdominal migraine
1. often associated with abdominal pain in addition to headaches
2. in some kids, the abdo pain predominates
3. attacks of abdo pain
  1. midline
  2. associated with vomiting
  3. associated with facial pallor
4. usually a personal or family hx of migraine
irritable bowel syndrome
1. also common in adults
2. associated w/ altered GI motility & abnormal sensation of GI events
3. Sx may occur ff a GI infection
4. abnormally forceful contractions thought to occur
  1. modulated by stress and anxiety
5. pain experienced at lower volumes of inflation of bowel than normal
  1. modulated by stress and anxiety
6. often a +ve fam hx present
7. characteristic set of sx
  1. not all pts have every sx
  2. abdo pain
    1. often worse before, or relieved by defecation
  3. explosive, loose or mucousy stools
  4. feeling of incomplete defecation
  5. contsipation
    1. often alternating w/ normal or loose stools
peptic ulceration, gastritis & functional dyspepsia
1. duodenal ulcers uncommon in children
  1. but consider if epigastric pain
    1. especially if it wakes child at night
  2. consider if hx of peptic ulceration in 1st degree relative
2. assocn btw H. pylori and duodenal ulcer in kids is not as strong as in adults
3. nodular antral gastritis
  1. caused by H. pylori
    1. usually IDed in antral gastric biopsies
    2. make urease
      1. C13 breath test
        ff admin of 13 C labelled urea by mouth
        detect presence
    3. stool antigen for H. pylori
      1. may be +ve in infected kids
    4. serological tests unreliable in kids
  2. assoc w/
    1. abdo pain
    2. nausea
4. Rx
  1. if peptic ulceration suspected
    1. proton pump inhibitors
      1. e.g. omeprazole
    2. and if H. pylori infection suggested by ix
      1. eradication therapy
        amoxicillin + metronidazole/clarithromycin
      2. failure to respond to Rx or symptoms recur on stopping Rx
        upper GI endoscopy
        if normal
        functional dyspepsia diagnosed
5. functional dyspepsia
  1. sx of peptic ulceration
  2. non-specific sx
    1. early satiety
    2. bloating
    3. postprandial vomiting
    4. delayed gastric emptying
  3. Rx
    1. hypoallergenic diet
      1. some kids respond
    2. difficult

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Recurrent abdominal pain- abdo migraine, peptic ulceration, IBS

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	Created by v.djabatey over 10 years ago