Paediatrics gastroenterology
Recurrent abdominal pain - ANSWERChild presents with repeated episodes of abdominal pain without an
identifiable underlying cause. The pain is described as non-organic or functional. This is common and can lead
to psychosocial problems, such as missed days at school and parental anxiety.
Episodes of central abdominal pain lasting more than 1 hour. Associated with N&V, pallor, headache,
photophobia and aura - ANSWERAbdominal migraine - examinations will be normal.
Acute mx of abdominal migraine - ANSWERLow stimulus environment (quiet, dark room)
Paracetamol
Ibuprofen
Sumatriptan
Preventative Mx of abdominal migraine - ANSWERPizotifen, a serotonin antagonist (MAIN preventative
medication)
Propranolol, a non-selective beta blocker
Cyproheptadine, an antihistamine
Flunarazine, a calcium channel blocker
Pizotifen - ANSWERserotonin antagonist
blocks the 5-HT2A and 5-HT2C receptors
used in migraine prevention
Needs to be withdrawn slowly when stopping as associated with withdrawal symptoms e.g. depression,
anxiety, poor sleep and tremor
Rabbit dropping stools - ANSWERSuggest constipation
, Encopresis - ANSWERTerm for faecal incontinence. Not considered pathological until 4 years of age
secondary causes of constipation - ANSWERHirschsprung's disease
Cystic fibrosis (particularly meconium ileus)
Hypothyroidism
Spinal cord lesions
Sexual abuse
Intestinal obstruction
Anal stenosis
Cows milk intolerance
Complications of chronic constipation - ANSWERDesensitisation of the rectum - over time they loose sensation
of the need to open the bowels leading to faecal impaction leading to stretching of the rectum and further
desensitisation -> encopresis
Ribbon stool - ANSWERSign of anal stenosis
Red flags - ANSWERNot passing meconium within 48 hours of birth (cystic fibrosis or Hirschsprung's disease)
Neurological signs or symptoms, particularly in the lower limbs (cerebral palsy or spinal cord lesion)
Vomiting (intestinal obstruction or Hirschsprung's disease)
Ribbon stool (anal stenosis)
Abnormal anus (anal stenosis, inflammatory bowel disease or sexual abuse)
Abnormal lower back or buttocks (spina bifida, spinal cord lesion or sacral agenesis)
Failure to thrive (coeliac disease, hypothyroidism or safeguarding)
Recurrent abdominal pain - ANSWERChild presents with repeated episodes of abdominal pain without an
identifiable underlying cause. The pain is described as non-organic or functional. This is common and can lead
to psychosocial problems, such as missed days at school and parental anxiety.
Episodes of central abdominal pain lasting more than 1 hour. Associated with N&V, pallor, headache,
photophobia and aura - ANSWERAbdominal migraine - examinations will be normal.
Acute mx of abdominal migraine - ANSWERLow stimulus environment (quiet, dark room)
Paracetamol
Ibuprofen
Sumatriptan
Preventative Mx of abdominal migraine - ANSWERPizotifen, a serotonin antagonist (MAIN preventative
medication)
Propranolol, a non-selective beta blocker
Cyproheptadine, an antihistamine
Flunarazine, a calcium channel blocker
Pizotifen - ANSWERserotonin antagonist
blocks the 5-HT2A and 5-HT2C receptors
used in migraine prevention
Needs to be withdrawn slowly when stopping as associated with withdrawal symptoms e.g. depression,
anxiety, poor sleep and tremor
Rabbit dropping stools - ANSWERSuggest constipation
, Encopresis - ANSWERTerm for faecal incontinence. Not considered pathological until 4 years of age
secondary causes of constipation - ANSWERHirschsprung's disease
Cystic fibrosis (particularly meconium ileus)
Hypothyroidism
Spinal cord lesions
Sexual abuse
Intestinal obstruction
Anal stenosis
Cows milk intolerance
Complications of chronic constipation - ANSWERDesensitisation of the rectum - over time they loose sensation
of the need to open the bowels leading to faecal impaction leading to stretching of the rectum and further
desensitisation -> encopresis
Ribbon stool - ANSWERSign of anal stenosis
Red flags - ANSWERNot passing meconium within 48 hours of birth (cystic fibrosis or Hirschsprung's disease)
Neurological signs or symptoms, particularly in the lower limbs (cerebral palsy or spinal cord lesion)
Vomiting (intestinal obstruction or Hirschsprung's disease)
Ribbon stool (anal stenosis)
Abnormal anus (anal stenosis, inflammatory bowel disease or sexual abuse)
Abnormal lower back or buttocks (spina bifida, spinal cord lesion or sacral agenesis)
Failure to thrive (coeliac disease, hypothyroidism or safeguarding)
