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1/ Chronic abdominal pain - A patient was presented in MR this week - CAPain x 2 years. Using the approach to acute AP can help but it really requires a separate approach.
Chronic AP: Chronic abdominal pain is pain that is present for more than three months.
Chronic AP: Chronic abdominal pain is pain that is present for more than three months.
2/ It requires a location- and character-based approach
Many times, the problem has undergone workup without any answers. However, this can be a dynamic process which can unmask its true nature months- years out from the index presentation.
Many times, the problem has undergone workup without any answers. However, this can be a dynamic process which can unmask its true nature months- years out from the index presentation.
3/ This process also incorporates the domain of chronic pelvic pain which can involve
-hard to diagnose disorders such as IBS, endometriosis or chronic appendicitis or uterine fibroids.
- Always start with alarm symptoms/Red flags as a mental checklist so not to miss a major Dx.
-hard to diagnose disorders such as IBS, endometriosis or chronic appendicitis or uterine fibroids.
- Always start with alarm symptoms/Red flags as a mental checklist so not to miss a major Dx.
4/ Two broad categories of chronic abdominal pain are
- Organic - physiologic, structural, or biochemical abnormalities
- Functional - ill defined and poorly localized or periumbilical and may have autonomic features (eg, pallor, nausea, dizziness, headache, or fatigue)
- Organic - physiologic, structural, or biochemical abnormalities
- Functional - ill defined and poorly localized or periumbilical and may have autonomic features (eg, pallor, nausea, dizziness, headache, or fatigue)
6/A quick review of Alarm findings:
weight loss/fever
Pain that awakens
Difficulty swallowing or painful swallowing
Vomiting
Diarrhea
Urinary symptoms
Back pain
Family history of inflammatory bowel disease (IBD), celiac disease, or PUD
Skin changes (eg, rash, eczema, hives)
weight loss/fever
Pain that awakens
Difficulty swallowing or painful swallowing
Vomiting
Diarrhea
Urinary symptoms
Back pain
Family history of inflammatory bowel disease (IBD), celiac disease, or PUD
Skin changes (eg, rash, eczema, hives)
7/If warning signs are absent and no obvious underlying etiology is identified, patients should be stratified into low-risk versus high-risk categories based on age and associated symptoms.
High-risk patients (age ≥60 years or alarm features) may require additional evaluation
High-risk patients (age ≥60 years or alarm features) may require additional evaluation
8/ Alarm findings on Physical exam:
Weight loss
Oral ulcers or perianal abnormalities (eg, skin tags, fissures, fistulae)
Localized or lateralized abdominal pain, suprapubic tenderness, or costovertebral angle tenderness
Hepatosplenomegaly
Weight loss
Oral ulcers or perianal abnormalities (eg, skin tags, fissures, fistulae)
Localized or lateralized abdominal pain, suprapubic tenderness, or costovertebral angle tenderness
Hepatosplenomegaly
5/Chronic abdominal pain has a vast number of causes many of which are not apparent on the initial visit.
Start with an approach
-Identify alarm findings
-Identify contributing factors
-Form a therapeutic alliance with the pt- we might not have an answer but pt reassurance helps
Start with an approach
-Identify alarm findings
-Identify contributing factors
-Form a therapeutic alliance with the pt- we might not have an answer but pt reassurance helps
