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  1. Abdominal Pain: Hot or Not Abdulwahab Telmesani MD College of Medicine Umm Al-Qura University

  2. Abdominal Pain: Hot or Not!

  3. Abdominal Pain • Acute • Chronic

  4. Acute Abdominal Pain • 5% of the unscheduled visits to clinics • Sense of urgency • Gets proper attention

  5. Chronic Abdominal Pain • Pathological (Organic abdominal pain). • Functional abdominal pain (Non organic)

  6. Chronic Abdominal Pain(Non organic/Functional)?

  7. Chronic Abdominal Pain(Non organic/Functional) No objective evidence of an Underlying organic disorder.

  8. Chronic Abdominal Pain(Pathological)?

  9. Chronic Abdominal Pain(Pathological)? Alarm symptoms or signs RED FLGS

  10. Chronic Abdominal PainPathological • Weight loss.

  11. Chronic Abdominal PainPathological • Weight loss. • Gastrointestinal bleeding.

  12. Chronic Abdominal PainPathological • Weight loss. • Gastrointestinal bleeding. • Persistent fever.

  13. Chronic Abdominal PainPathological • Weight loss. • Gastrointestinal bleeding. • Persistent fever. • Chronic severe diarrhea.

  14. Chronic Abdominal PainPathological • Weight loss. • Gastrointestinal bleeding. • Persistent fever. • Chronic severe diarrhea. • Significant vomiting.

  15. Chronic / Functional Abdominal Pain Why?

  16. Chronic / Functional Abdominal Pain • A common problem • Indication of higher prevalence in our society • It is a cry for help

  17. Chronic / Functional Abdominal PainTerms Used

  18. Chronic / Abdominal PainTerms Used Chronic recurrent abdominal pain RAP Functional abdominal pain Nonorganic abdominal pain Psychogenic abdominal pain Rome II criteria for abdominal pain

  19. Chronic recurrent abdominal pain (RAP) 3 episodes of abdominal pain, over a period of 3 mo, severe enough to affect activities

  20. Functional abdominal pain Abdominal pain that occurs in the absence of anatomic abnormality, inflammation, or tissue damage

  21. Functional abdominal pain Used interchangeably with: Nonorganic abdominal pain & Psychogenic abdominal pain

  22. Rome II criteria for abdominal pain?

  23. Rome II criteria for abdominal pain In 1999, a group of investigators (Rome II committee) was charged with identifying and then developing diagnostic criteria for childhood functional disorders including recurrent abdominal pain.

  24. Rome II criteria for abdominal pain • Functional dyspepsia. • Irritable Bowel Syndrome (IBS). • Functional abdominal pain. • Abdominal migraine.

  25. Rome II criteria for abdominal pain • Functional dyspepsia. Upper abdominal pain, recurrent or persistent x 12 wks. Non organic.

  26. Rome II criteria for abdominal pain • Functional dyspepsia. Upper abdominal pain, recurrent or persistent x 12 wks. Non organic. • Irritable Bowel Syndrome (IBS). Abdominal discomfort x 12wks + changed stool frequency and form.

  27. Rome II criteria for abdominal pain • Functional dyspepsia. Upper abdominal pain, recurrent or persistent x 12 wks. Non organic. • Irritable Bowel Syndrome (IBS). Abdominal discomfort x 12wks + changed stool frequency and form. • Functional abdominal pain. Abdominal pain more than 12 wks in a school-aged child or adolescent.

  28. Rome II criteria for abdominal pain • Functional dyspepsia. Upper abdominal pain, recurrent or persistent x 12 wks. Non organic. • Irritable Bowel Syndrome (IBS). Abdominal discomfort x 12wks + changed stool frequency and form. • Functional abdominal pain. Abdominal pain more than 12 wks in a school-aged child or adolescent. • Abdominal migraine In the preceding 12 mo three or more paroxysmal episodes of intense, acute midline, abdominal pain lasting 2 h to several days, with intervening symptom-free intervals lasting weeks to months. (2 of; headache, one side, photophobia FHx, Aura)

  29. Epidemiology

  30. 13% of middle-school students and 17% of high-school students experience weekly abdominal pain. Hyams JS et al J Pediatr. 1996

  31. Functional Abdominal Pain Up to 15% of the school age children. Youssef NN. Clinical Pediatrics 2007

  32. IN KSA

  33. RAP was found in 55/314 (17.5%). 27/55(26.2%) middle school students. 28/55(13.3%) secondary school students. Telmesani A. 2006 (unpublished)

  34. Associated complaints/symptoms

  35. Associated complaints/symptoms • Headache, • Joint pain, • Anorexia, • Vomiting, • Nausea, • Excessive gas, and altered bowel symptoms.

  36. Our bowl is a mirror for our emotions !

  37. The pain is real. The child is not faking

  38. RAP & Anxiety children meeting criteria for RAP endorsed significantly greater trait anxiety, anxiety sensitivity, pain anxiety, and somatic symptoms as compared to those not meeting RAP criteria Drews, Amanda. Dissertation 2006

  39. The impact of recurrent abdominal pain: predictors of outcome in a large population cohort. Children with recurrent abdominal pain are at significant and continuing risk of adverse functioning. Ramchandani, Paul G. et al Acta Paediatrica. 2007.

  40. School stressors, psychological complaints and psychosomatic pain. School stressors are strongly associated with psychosomatic pain and psychological complaints in school children. Hjern A. et al Acta Paediatrica. 2008.

  41. Recurrent abdominal pain, anxiety, and depression in primary care. Anxiety disorders were significantly more likely to precede RAP. Ramchandani, Paul Child: Care, Health & Development 2004

  42. The significance of life-events as contributing factors in childhood RAP This study strongly suggests that recent stressful life-events are important risk-factors for RAP. Boey CC ; Goh KL J Psychosom Res.  2001

  43. IN KSA

  44. Relation of Anxiety and Depression with Psychosomatic Symptoms in children at a Primary Health Care center at Makkah Al-Mukarama 2003 Halah S. Dahlan (MOH)

  45. Results • The relation of Anxiety and Psychosomatic Symptoms (RAP) represents 53% of the cases. • The relation of Depression and Psychosomatic Symptoms (RAP) represents 57% of the cases.

  46. Conclusion • RAP is the most common indicator of psychological problems which can be detected and handled at early stages.