Pediatric Abdominal Pain Assessment

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Questions and Answers

Which of the following is a common symptom associated with irritable bowel syndrome according to the text?

Regular, formed bowel movements.

Weight gain.

Explosive, loose, or mucousy stools. (correct)

Decreased appetite

What is a key step in the initial evaluation of a child with abdominal complaints, as discussed?

Excluding structural heart defects.

An immediate colonoscopy.

Genetic testing for cystic fibrosis.

A urine microscopy and culture. (correct)

When should further investigations for abdominal pain be performed in children, as described in the text?

When there is associated fever

As a routine check for all children.

Only if clinically indicated. (correct)

Always after a detailed history of the child.

What is a potential cause of abdominal pain in children that should be considered if symptoms include epigastric pain waking the child at night?

Duodenal ulcers. (A) Signup and view all the answers

What should be explained to children and parents regarding functional dyspepsia and irritable bowel syndrome, according to the text?

Sometimes the intestines can become very sensitive. (B) Signup and view all the answers

What should be checked in the case of Irritable bowel syndrome symptoms?

Coeliac antibodies and thyroid function tests. (A) Signup and view all the answers

The text mentions that H.pylori is a predisposing factor to which condition?

Duodenal ulcers. (B) Signup and view all the answers

What is the long-term prognosis for about half of children with abdominal pain issues as described in the text?

The symptoms rapidly become free of symptoms. (C) Signup and view all the answers

What is a frequent cause of recurrent abdominal pain in children that must be ruled out?

Constipation (D) Signup and view all the answers

What has research shown regarding the relationship between psychogenic pain and recurrent abdominal pain in children?

Studies have failed to show a significant difference in psychogenic pain between children with and without recurrent abdominal pain. (C) Signup and view all the answers

How might anxiety contribute to a child's experience of abdominal pain?

Anxiety can alter bowel motility which may be perceived as pain. (B) Signup and view all the answers

What is the most common location for intussusception?

The ileum passing through the ileocaecal valve into the caecum (C) Signup and view all the answers

Which gastrointestinal condition is most likely to occur as a result of gut motility issues?

Irritable bowel syndrome (D) Signup and view all the answers

What age range is intussusception most commonly observed in children?

3 months to 2 years (D) Signup and view all the answers

What is the primary goal of initial management when a child presents with recurrent abdominal pain?

To identify serious underlying causes while reassuring the child and parents. (D) Signup and view all the answers

Which of the following is a typical clinical feature of intussusception?

Paroxysmal, colicky pain with redcurrant jelly stool (A) Signup and view all the answers

What is characteristic of abdominal migraine?

A shorter period of non-specific pain and pallor. (A) Signup and view all the answers

What might an abdominal X-ray reveal in a child with intussusception?

Distended small bowel and absence of gas in the distal colon or rectum (C) Signup and view all the answers

What physiological change is associated with irritable bowel syndrome in children?

Abnormally forceful contractions within the small intestine. (A) Signup and view all the answers

What did studies with inflated balloons in the intestine of adults, with irritable bowel syndrome, reveal?

They experience pain at substantially lower volumes compared to controls (C) Signup and view all the answers

What is a typical finding on abdominal ultrasound that can help confirm a diagnosis of intussusception?

The 'target/doughnut' sign (C) Signup and view all the answers

What is the primary initial treatment method for intussusception, assuming no peritonitis is present?

Rectal air insufflation by a radiologist (C) Signup and view all the answers

Why is intravenous fluid resuscitation often needed in patients with intussusception?

There is often pooling of fluid in the gut which may lead to hypovolaemic shock (C) Signup and view all the answers

In children more than 2 years of age, intussusception is more likely to be associated with which of the following?

A Meckel diverticulum or polyp (C) Signup and view all the answers

What is the primary purpose of contrast studies in the upper gastrointestinal tract when assessing gastro-oesophageal disease?

To rule out underlying anatomical abnormalities. (D) Signup and view all the answers

What is the typical pH level in the lower oesophagus of a healthy individual observed in a 24-hour pH study?

Maintains predominantly above 4. (C) Signup and view all the answers

What is the most appropriate initial step in managing uncomplicated gastro-oesophageal reflux, other than immediately starting fluid resuscitation?

Adding inert thickeners to feeds and small frequent meals. (A) Signup and view all the answers

What physiological observation might suggest the presence of pyloric stenosis during a physical exam?

A mass that feels like an olive palpable in the right upper quadrant. (C) Signup and view all the answers

What metabolic disturbance might be associated with significant vomiting due to gastrointestinal issues?

Hypochloraemic metabolic alkalosis with low plasma sodium and potassium. (C) Signup and view all the answers

In the context of gastro-oesophageal disease, which diagnostic method is characterized as neither sensitive nor specific?

Contrast studies of the upper gastrointestinal tract. (C) Signup and view all the answers

What does the presence of a wave moving from left to right across the abdomen suggest during a physical examination?

Gastric peristalsis. (A) Signup and view all the answers

What is a primary method used to calm an infant and allow for examination during the diagnostic process?

Providing a milk feed. (A) Signup and view all the answers

Which of the following conditions can mimic gastroenteritis due to a systemic infection?

Septicaemia (D) Signup and view all the answers

Which condition is NOT listed as a surgical disorder that can mimic gastroenteritis?

Otitis media (A) Signup and view all the answers

What condition is identified as a metabolic disorder that can mimic gastroenteritis?

Diabetic ketoacidosis (C) Signup and view all the answers

What is considered the most accurate measure of dehydration in a child with diarrheal illness?

Degree of weight loss during the illness (B) Signup and view all the answers

Which of the following local infections can mimic gastroenteritis?

Urinary tract infection (A) Signup and view all the answers

What condition is mentioned as a renal disorder that can mimic gastroenteritis?

Haemolytic uraemic syndrome (C) Signup and view all the answers

Which factor does NOT contribute to higher insensible water losses in older children compared to infants?

Immature renal tubular reabsorption (D) Signup and view all the answers

Why might a recent weight measurement be misleading when assessing dehydration in a child?

The child may have been weighed with clothes on. (B) Signup and view all the answers

What is the primary mechanism of sodium absorption in the intestine?

A glucose-sodium transporter that facilitates the co-absorption of the two. (D) Signup and view all the answers

How does sodium move from epithelial cells into the circulation?

Via an active transport process using sodium/potassium ATPase pumps. (A) Signup and view all the answers

Why does an oral rehydration solution, containing both sodium and glucose, increase water absorption?

Because the co-absorption of sodium and glucose creates an electrochemical gradient. (C) Signup and view all the answers

What is the role of the sodium-hydrogen exchanger in the gut?

It is a secondary active sodium uptake mechanism. (B) Signup and view all the answers

Why is it important to reduce plasma sodium slowly when correcting dehydration?

To avoid seizures and cerebral edema. (A) Signup and view all the answers

What rate of plasma sodium reduction is recommended when correcting dehydration?

Less than 0.5 mmol/l per hour. (D) Signup and view all the answers

Which of the following statements about oral rehydration solution is true in cases of inflammation of the gut?

It can be used and works effectively, even when the gut is inflamed. (D) Signup and view all the answers

According to the provided information, what is the most likely outcome of excessive loss of sodium and water?

Hypovolemia and potential seizures. (C) Signup and view all the answers

Study Notes

Gastroenterology Chapter 14

Learning Objectives: Covering vomiting, crying, acute abdominal pain, recurrent abdominal pain, gastroenteritis, malabsorption, chronic non-specific diarrhea, inflammatory bowel disease, constipation. Includes 'Red Flag' features for each condition.

Vomiting

Causes: Gastroesophageal reflux, feeding problems, infections (gastroenteritis), respiratory infections (whooping cough), urinary tract infections, meningitis, food allergies, intestinal obstruction (pyloric stenosis, atresia, intussusception, malrotation, volvulus, duplication cysts, strangulated inguinal hernia), Hirschsprung disease, inborn errors of metabolism, congenital adrenal hyperplasia, renal failure.
'Red Flag' Features: Bile-stained vomit, haematemesis, projectile vomiting (especially in first few weeks of life), vomiting with coughing, abdominal tenderness, abdominal distension, hepatosplenomegaly, blood in stool, severe dehydration, shock, bulging fontanelle, seizures, faltering growth, intestinal obstruction.

Crying

Overview: Infants cry for various reasons, including hunger, discomfort, and emotional responses.
Potential Causes: Undiagnosed fracture, inappropriate feeding or other infections, oesophagitis, torsion of the testis.

Acute Abdominal Pain

Causes: Acute appendicitis, intestinal obstruction (intussusception, malrotation), inguinal hernia, peritonitis, inflamed Meckel diverticulum, pancreatitis, trauma, urinary tract infection, acute pyelonephritis, hydronephrosis, renal calculus, Henoch-Schönlein purpura, diabetic ketoacidosis, sickle cell disease, hepatitis, inflammatory bowel disease, constipation, recurrent abdominal pain of childhood, gynaecological causes in pubertal females, psychological causes, lead poisoning, acute porphyria, unknown.
Key Points: In nearly half of children presenting with acute abdominal pain, no specific cause is found.

Recurrent Abdominal Pain

Features: Pain lasting at least 3 months, typically periumbilical, associated with an otherwise well child, and commonly with episodes of increased frequency and severity.
Causes: Functional conditions (irritable bowel syndrome, constipation, and less commonly coeliac disease, abdominal migraine, and functional dyspepsia), other possible causes rarely serious. Constipation is a frequent cause.

Gastroenteritis

Causes: Viruses (rotavirus, adenovirus, norovirus), bacteria (Campylobacter, Shigella, Salmonella), parasites (Giardia, Cryptosporidium), and other agents. Worldwide, gastroenteritis is amongst the most frequent causes of death in children under 5 years of age

Malabsorption

Causes: Cholestatic liver disease, biliary atresia, lymphatic leaks, short bowel syndrome, loss of terminal ileal function, exocrine pancreatic dysfunction (e.g., cystic fibrosis), small intestinal mucosal disease, enzyme defects, transport defects (e.g., glucose-galactose malabsorption).

Chronic Non-Specific Diarrhea

Description: Chronic, most common cause of persistent loose stools in preschool children. Varying stool consistency and often associated with undiagnosed diseases.

Inflammatory Bowel Disease (IBD)

Types: Crohn's disease (affecting any part of the GI tract) and Ulcerative colitis (confined to the colon).
Crohn's Disease: Transmural, focal, subacute or chronic inflammatory disease, commonly affecting the distal ileum and proximal colon. Often presents with lethargy and general ill health.
Ulcerative Colitis: Mucosal inflammation and ulceration confined to the colon. Characteristically presents with rectal bleeding, diarrhea and colicky pain.

Constipation

Overview: A common reason for child consultation. Can involve decreased frequency, harder stools, or painful defecation, and is highly variable with age.
Potential Causes: Dehydration, reduced fluid intake, anal fissures, problems with toilet training, anxiety, associated conditions like Hirschsprung disease, hypothyroidism, coeliac disease, or other neurological issues.

Intussusception

Description: The telescoping of one part of the intestine into another.
Presentation: Paroxysmal, severe colicky pain with pallor, abdominal mass, and the passage of redcurrant jelly stool.

Meckel Diverticulum

Description: A remnant of the vitello-intestinal duct that contains ectopic gastric mucosa or pancreatic tissue.
Presentation: May be asymptomatic or can present with bleeding, intussusception, diverticulitis.

Malrotation and Volvulus

Description: During fetal rotation of the small intestines, the mesentery may not secure properly.
Presentation: Intestinal obstruction often presents within the first 3 days of life with intestinal obstruction from Ladd bands, obstructing the duodenum or volvulus, and is highly variable with age.

Pyloric Stenosis

Description: Hypertrophy of the pyloric muscle, causing gastric outlet obstruction.
Presentation: Vomiting that progressively increases in frequency and forcefulness (projectile), occurring between 2-8 weeks of age, often accompanied by hunger, weight loss if presentation is delayed.

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Description

This quiz covers key concepts related to the evaluation and management of abdominal pain in children, including symptoms of irritable bowel syndrome and functional dyspepsia. It explores common causes, evaluation steps, and prognostic factors for recurrent abdominal pain in pediatric patients. Test your knowledge on these important aspects of child health.