Evaluation of Children with Chronic Abdominal Pain.

Lakshmidevi, G (2006) Evaluation of Children with Chronic Abdominal Pain. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Chronic abdominal pain is defined1,2 as abdominal pain, continuous or recurrent, lasting for two weeks or longer. Exact prevalence of chronic abdominal pain is not known. It seems to account for 2 to 4% of all pediatric outpatient visits. This condition has also been referred to as ‘recurrent abdominal pain’, in the literature. Apley and Naish first introduced it in pediatric literature in the year 1950. Chronic abdominal pain can be due to both organic and functional disorders. The following five components have been mentioned and considered in evaluating these children; the same have been followed in this study: 1.History, 2. Physical examination, 3. Laboratory tests individualized to indication, 4. Imaging studies individualized to indication, 5. Empiric intervention. In Chronic abdominal pain symptoms which are known to be associated with organic disease and referred as alarm symptoms are vomiting, diarrhea, unexplained fever, persistent right upper or right lower quadrant pain, weight loss and gastrointestinal blood loss. This condition has been greatly discussed and studied by paediatricians and medical gastroenterologists. Most of the published literature is from the medical colleagues. Available literature published by them has repeatedly mentioned functional gastrointestinal disorders as the cause of this pain, which includes non-ulcer dyspepsia, Irritable Bowel Syndrome or abdominal migraine. This being the case there has been debate regarding the need for evaluating these patients with laboratory tests and imaging studies. But the surgeons have approached this problem differently. Various imaging modalities and Diagnostic laparoscopy have been used which has increased the yield of diagnosing organic diseases in these studies. Chronic or recurrent appendiceal inflammation has been shown to be one of the causes of this pain in various published studies. There are no clear guidelines in literature regarding the investigations needed in evaluating these patients. There are no studies quoting the differential diagnosis in these patients. AIMS : To determine the differential diagnosis of chronic abdominal pain. To determine the yield of various investigatory modalities in managing chronic abdominal pain. To determine the role of Diagnostic laparoscopy in managing patients with chronic abdominal pain. To determine if appendicectomy is indicated in patients presenting with chronic abdominal pain when no conclusive diagnosis is reached with investigations. CONCLUSION : 1. Chronic abdominal pain in children needs a complete and thorough evaluation with various modalites of deserving investigations, but a proper history and clinical examination are indispensable. 2. A majority of our patients (78%) had organic pathology revealed by protocolised evaluation. 3. The commonest cause of chronic abdominal pain is due to gastrointestinal pathology followed by urological pathology. Rare pathologies also should be considered. 4. Ultrasonography has the highest diagnostic yield among investigations. It is a non-invasive, inexpensive, easily available test, which can be done as an outpatient procedure. USG should be done as a routine in all cases. 5. In the modern era, diagnostic laparoscopy surely has a place in evaluating these patients. It gives better diagnostic yield, can be therapeutic, is less painful post-operatively and is cosmetically acceptable. It was therapeutic in 43.3% of our cases. 6. Congenital anomalies like Malrotation, Choledochal cyst, MURCS association, Retroperitoneal lymph cyst can present even at an older age. 7. Unsuspected tuberculosis is still prevalent in Indian scenario. 8. As against common Paediatric practice, pancreatic pathology and urolithiasis should be considered as a diagnosis in children. 9. Delay in diagnosis and treatment of oncological pathologies can be avoided by early evaluation. 10.Chronic appendicitis is an established entity and should be considered as a differential diagnosis in all these patients, especially if presenting with chronic right lower abdominal pain.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Chronic Abdominal Pain ; Children ; Evaluation.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 31 Jul 2017 04:08
Last Modified: 31 Jul 2017 04:08
URI: http://repository-tnmgrmu.ac.in/id/eprint/2358

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