Chronic abdominal pain in children: help in spotting the organic diagnosis

Wright, Naomi Jane; Hammond, Philip; Curry, Joe

doi:10.1136/archdischild-2012-302273

Cited by 9 publications

(5 citation statements)

References 23 publications

(18 reference statements)

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“…1,3 In a study conducted in the United Kingdom (UK), 10-14% of school-age children were diagnosed with recurrent abdominal pain, and 5-10% of these were due to organic causes. 9,10 The diagnosis of chronic appendicitis is based on history taking, physical examination, and laboratory tests. From the history, the child has complained of recurrent abdominal pain since 3 months before 2487 admission.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Chronic Appendicitis in Children: A Case Report

Amadea

Jurnalis

2022

Bioscmed

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Background: Abdominal pain was one of the most complaints in children. Chronic appendicitis was the common cause of recurrent abdominal pain. The incidence of this case was 1,5% of all appendicitis cases. The manifestation was not specific, and one of the treatment options was surgical with laparotomy or laparoscopy methods. Case presentation: A 10-year-old boy came to the outpatient clinic of gastroenterohepatology with a diagnosis of abdominal pain caused by chronic appendicitis differential diagnosis of chronic gastritis with abdominal pain, especially the pit of the stomach moving to the right waist since 3 months ago. Physical examination of the patient showed the general condition was moderate, conscious, and normal vital signs. Abdominal distension was absent, tenderness in the lower right abdomen was present, and the pain was present in the lower right abdomen. There was contralateral tenderness in the left lower abdomen. An appendicogram examination shows chronic appendicitis. The patient was consulted for pediatric surgery for appendectomy and later controlled to a surgical outpatient clinic after discharge. Conclusion: Chronic appendicitis usually shows unspecific manifestation and physical examination. Early diagnosis and surgical treatment are options to treat appendicitis in children.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Chronic Appendicitis in Children: A Case Report

Amadea

Jurnalis

2022

Bioscmed

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“…abnormal growth, fever, uveitis, mouth ulcers, erythema nodosum, arthritis, icterus, suspected anemia, persistent abdominal pain localized in the right upper or lower quadrant, and/or perianal abnormalities). Finally, patients under 4 years of age were excluded due to a higher pre-test probability of underlying somatic causes [45].…”

Section: Methodsmentioning

confidence: 99%

“…According to the guidelines, extensive diagnostic tests are not recommended in view of a low pre-test probability of finding a somatic cause [3]. In addition, this policy may serve to reduce financial costs, minimize nonspecific findings, and remove fear for painful diagnostic testing [456]. Despite well-defined guidelines, it is unknown whether pediatricians adhere to the guidelines during daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain

Kalleveen

Noordhuis

Lasham

et al. 2019

Pediatr Gastroenterol Hepatol Nutr

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Purpose To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. Methods The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and inter-observer variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. Results A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35–0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower inter-observer variability than in the retrospective study. Adherence to the guideline was 66.8%. Conclusion We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.

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“…laborchemische Diagnostik ist bei Abwesenheit von Alarmzeichen nicht hilfreich im Nachweis organischer Erkrankungen und wird daher nicht routinemäßig empfohlen (6,15). Eine weitere Abklärung ändert sehr selten das Management und hat auch keinen positiven Einfluss auf die Prognose, kann aber beim Nachweis von klinisch unbedeutenden Nebenbefunden zu unnötigen Tests und Verängstigungen der betroffenen Kinder und Eltern führen (16)(17)(18).…”

Section: Alarmzeichen In Der Abklärung Dyspeptischer Beschwerdenunclassified

Dyspepsie im Kindes- und Jugendalter

Kögler¹,

Vécsei²

2014

Kinder- und Jugendmedizin

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ZusammenfassungDyspepsie ist ein häufiger Konsultationsgrund in der kinder- und jugendärztlichen Praxis, wobei die Differenzierung zwischen somatischen und funktionellen Ursachen häufig eine Herausforderung darstellt. In einer systematischen, patientenorientierten und ökonomischen Abklärung sind eine ausführliche Anamnese und eine sorgfältige klinische Untersuchung mit besonderem Fokus auf Alarmzeichen von zentraler Bedeutung. Sind Alarmzeichen vorhanden, werden weiterführende Untersuchungen im Hinblick auf organische Ursachen notwendig. Können die dyspeptischen Beschwerden auf eine organische Erkrankung zurückgeführt werden, steht meist eine evidenzbasierte Therapieoption zur Verfügung. Bei Abwesenheit von Alarm-zeichen ist in erster Linie von einer funktionellen Dyspepsie auszugehen, bei der eine umfangreiche apparative Diagnostik entbehrlich ist. Die Therapie der funktionellen Dyspepsie basiert auf einem biopsychosozialen Zugang inklusive psychologisch-psycho-therapeutischer Unterstützung, medikamentöser Therapie und Lebensstilmodifikation.

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Chronic abdominal pain in children: help in spotting the organic diagnosis

Cited by 9 publications

References 23 publications

Diagnosis and Management of Chronic Appendicitis in Children: A Case Report

Diagnosis and Management of Chronic Appendicitis in Children: A Case Report

Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain

Dyspepsie im Kindes- und Jugendalter

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