1	Chronic Abdominal Pain William R. Dailey, MD, MS
2	Background Greater than 1/3 of children complain of abdominal pain lasting 2 weeks or longer Most often idiopathic Doctors, parents and children often frustrated and anxious Differential is VERY broad Systematic approach needed
3	Approach History and Physical Labs Imaging Interventions
4	History Pain (location, intensity, quality/character, duration,when) Appetite, satiety, diet, nausea, vomiting, Stool consistency, pattern (diarrhea/constipation) Weight, growth, fever, rash, developmental delay Palliative interventions attempted (meds/food)
5	History (cont) Family history of abdominal problems Personal history (stooling at birth) Effect on socialization, school, activities Night pain that awakes a child from sleep, peripheral abdominal pain, persistent vomiting, blood in stool, weight loss, fever, painful urination, chronic cough, and pain after eating specific foods
6	Physical Weight, height, growth, pubertal stage, Vitals Location of pain, mass, rebound Liver, spleen, kidneys, flank pain Rectal and pelvic, hemoccult stool
7	Labs CBC ESR U/A with Culture Stool studies (O&P, giardia antigen, PMN) CMP, amylase Pregnancy test, cultures H pylori
8	Imaging Abdominal U/S Pelvic U/S Upper GI with followthrough, CT abd EGD, Colonoscopy Laparoscopy
9	Empiric Interventions Education Symptom diary (pain, bowel pattern,diet) Adjust fiber Reduce milk products Reduce juice H2 blockers/PPIs
10	Recurrent Abd Pain Syndrome Bimodal 5-7 years (M=F) Separation? And 8-12 years (M<<F) Pain is vague and unrelated to meals, activity or stool pattern (epigastric in some) Apley No awakening from sleep Can have pallor, N, dizziness, HA and fatigue
11	RAPS FH IBS? PE normal Labs Normal Acknowledge pain is real Remain in school, continue activities,normal diet Psych if persistently incapacitated
12	Constipation Evacuate daily with lactulose, mineral oil first Then MOM, Senna Can assist with enema or suppositories Adjust softeners and stimulants to get 2 soft stools per day for 6-8 weeks Then transition off
13	Peptic Disease early morning pain, early satiety, night arousal and a positive family history epigastric or periumbilical but consistent Ulcers commonly occult blood Duodenal (M>F) > Gastric (M=F) NSAIDS, Chronic Diseases = stress ulcers EGD for bleeding, weight loss, anorexia or chest pain, pain > 4 weeks on H2 blocker
14	Peptic Disease
15	IBD Pain in lower abdomen Cramping and increases after meals or activity