December Week 1: Chronic Abdominal Pain

  1. Rasquin A, et al. Childhood Functional Gastrointestinal Disorders: Child/Adolescent. Gastroenterology. 2006;130:1527–1537
  2. Collins B, et al. Chronic Abdominal Pain. Peds in Review. 2007; 28:323-331.

Case 1:
An 8 year old girl is brought in by her mom because she is concerned about how much time she spends in the bathroom. The girl reports she has severe abdominal cramping that feels better after a bowel movement, but she often feels like she still has to go and so she stays in the bathroom for up to an hour. She thinks it all started 6 months ago when she had a bout of diarrhea, and her stools have been loose ever since.
What other questions will you ask? 
What is the most likely diagnosis?
What do you suggest for treatment?

Case 2:
A 12 year old boy comes to your office for follow up after an ER visit for abdominal pain. He reports that he had been watching a movie when he developed a severe headache, nausea, abdominal pain, and nonbilious, nonbloody vomiting. This is the 4th similar episode this year. Mom reports she has occasional headaches but otherwise family history is negative for any neurologic or GI problems.
What is the most likely diagnosis and how would you treat him?

Case 3:
You are seeing a 6 year old female for an acute visit for intermittent abdominal pain over the last 3 months. Mom reports she complains of her “tummy hurting” a few times every week and points to the area above her umbilicus. She has not had any diarrhea or constipation. She has been sent home from school several times. Mom reports she feels better with a snack and a hot pad on her belly.
What other questions will you ask? 
What is the most likely diagnosis? 
What is the utility of testing for H pylori? 
What do you suggest for treatment?

Case 4:
A 14 year old girl presents to your office for school forms and on ROS she admits to abdominal pain. She describes the pain as intermittent, crampy, but does not interfere with her activities. She notes her appetite has decreased, but she thought this was due to the canker sores she’s had the last week as well as not exercising as much due to achiness. She denies diarrhea but thinks her stools have become looser and darker.
What is the most likely diagnosis? 
What is your next step?