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Recurrent Abdominal Pain Syndrome

Aka: Recurrent Abdominal Pain Syndrome, Functional Abdominal Pain in Children
  1. Definition
    1. Pain occurs at least once/month for at least 3 months
    2. Ages 5 - 16 years (peaks at age 9 years)
    3. Affects activity, school attendance
  2. Epidemiology
    1. Prevelance
      1. School age children: 10-15%
      2. Pre-teen and teenage children: 20%
  3. Pathophysiology
    1. Autonomic Dysfunction with altered intestinal motility
    2. Hyperalgesia and altered sensory pathways
  4. Causes
    1. Functional Abdominal Pain in most cases
      1. Dyspepsia
      2. Irritable Bowel Syndrome
      3. Abdominal Migraine
      4. Functional Constipation
      5. Cyclical Vomiting
      6. Adolescent Rumination Syndrome
    2. Organic cause in 3-8% of cases (see differential diagnosis below)
      1. See Abdominal Pain Causes
  5. Risk Factors
    1. School Phobia (and related stresses) closely associated
    2. Parents (especially mothers) often have Anxiety Disorder or Major Depression
  6. Associated Conditions
    1. Anorexia Nervosa
  7. Symptoms
    1. Nonspecific recurrent Abdominal Pain
      1. Typically periumbilical or epigastric, ill-defined pain
      2. Not related to meals
      3. Not related to movement or activity
    2. Nausea or Vomiting may be present depending on type
    3. No Dysuria
  8. Signs
    1. Well appearing child
    2. Exam is often normal or mild abdominal tenderness
    3. Normal growth curves (or Body Mass Index for age)
  9. Signs: Red flags
    1. Pain location distant from Umbilicus
    2. Pain that awakens child at night
    3. Erythrocyte Sedimentation Rate (ESR) or C-Reactive Protein (C-RP) elevated
    4. Weight loss
    5. Blood in stool
  10. Labs (Limited and focused work-up)
    1. Stool for Ova and Parasites for 3 samples
      1. Giardia is common cause of recurrent Abdominal Pain
    2. Urinalysis
    3. Complete Blood Count (CBC)
    4. Erythrocyte Sedimentation Rate (ESR)
    5. C-Reactive Protein
  11. Imaging
    1. Flat and upright abdominal XRay (KUB)
    2. Consider RUQ Ultrasound
    3. Consider pelvic Ultrasound
  12. Differential Diagnosis
    1. Crohn's Disease
    2. Peptic Ulcer Disease
    3. Carbohydrate intolerance
    4. Appendiceal colic
    5. Nephrolithiasis (Ureteropelvic junction obstruction)
    6. Giardia
    7. Blastocystis hominis
    8. Hereditary Pancreatitis
    9. Abdominal Migraine
    10. Epilepsy
    11. Gynecologic disorder
    12. Psychiatric disorder or abuse
      1. Major Depression
      2. Generalized Anxiety Disorder
      3. Sexual Abuse
      4. Physical abuse
      5. Conversion reaction
  13. Management
    1. Avoid Medications
      1. Peppermint Oil capsule three times daily has been used
    2. Emphasize the patient's response to pain
    3. Involve the parents
    4. Reassure that the problem is NOT life threatening
    5. Be realistic and frank
      1. Problem may persist for extended period of time
    6. Treat suspected Constipation aggressively
      1. Mineral Oil
      2. Lactulose
      3. Fleet Enema
    7. Promote full activity and a sense of health
    8. Encourage a well balanced diet
    9. Encourage adequate hydration
    10. Encourage adequate fiber intake
    11. Maintain school attendance
  14. Course
    1. Usually resolves by age 20 years
    2. Irritable Bowel Syndrome may develop
  15. Prognosis
    1. These children often get lower grades than peers
  16. References
    1. Thiessen (2002) Pediatr Rev 23(2):39-46 [PubMed]
    2. Claudius in Majoewsky (2012) EM:RAP-C3 2(3): 3

Functional abdominal pain (C1609533)

Concepts Sign or Symptom (T184)
Dutch functionele buikpijn
French Douleur abdominale fonctionnelle
German funktionelle Bauchschmerzen
Italian Dolore addominale funzionale
Portuguese Dor abdominal funcional
Spanish Dolor abdominal funcional
Japanese 機能性腹痛, キノウセイフクツウ
Czech Funkční břišní bolest
Hungarian Funkcionális hasfájás
English Functional abdominal pain
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Recurrent abdominal pain (C2585575)

Concepts Sign or Symptom (T184)
SnomedCT 439469002
English Recurrent abdominal pain (finding), Recurrent abdominal pain, Recurrent abdominal pains
Spanish dolor abdominal recurrente (hallazgo), dolor abdominal recurrente
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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