Recurrent Abdominal Pain

Chapter 115 Recurrent Abdominal Pain




Clinical Case Problem 1: A 13-Year-Old Girl with Recurrent Abdominal Pain


A 13-year-old girl is brought to your office with a history of recurring abdominal pain. She has had episodes of abdominal pain around twice per week for the past 3   months. These episodes last approximately 6 to 8   hours. You have seen her for the same problem on many occasions. The following were done previously, and all results were normal: complete blood count (CBC); erythrocyte sedimentation rate (ESR); urinalysis; stool examination for ova and parasites; ultrasound examination of the kidneys, ureter, and bladder (KUB); and abdominal plain film. The pain is described as a “dull ache” around her umbilical area. She rates the pain at a baseline of 6/10, which increases to 8/10 and decreases to 4/10 at times. It is not associated with any food intake, and it is not associated with any diarrhea or constipation. Her mother says that she has been missing school because of the pain.


On physical examination, the girl is in no apparent distress. Her vital signs, height, and weight are normal for her age. On abdominal examination, there is slight tenderness in the area of the periumbilical region. There is no hepatosplenomegaly, and there are no other masses.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. functional abdominal pain (recurrent abdominal pain [RAP] syndrome)

b. lactose intolerance

c. Crohn disease

d. mesenteric lymphadenitis

e. chronic appendicitis

2. What is the prevalence of this condition in children?


a. 1%

b. 5%

c. 15%

d. 20%

e. 25%

3. Regarding the basis for the pain that occurs in the condition described here, which of the following statements is (are) true?


a. there is close association with school phobia

b. the pain can involve an alteration in the patient’s pain threshold, such as hyperalgesia

c. there is evidence that an abnormality in the autonomic nervous system is involved in this condition

d. there is evidence that intestinal motility can be affected

e. all of the above

4. Which of the following statements regarding this patient’s condition is (are) true?


a. there is no association between school attendance and the condition described

b. school phobia (reluctance to attend school) is not a contributing factor in most cases

c. children with this condition usually achieve higher grades than their counterparts without this condition

d. there is an association between stressful events at school and this condition

e. all of the above

5. Which of the following should be considered “red flags” in the history of RAP syndrome?


a. generalization of the pain

b. constitutional symptoms, such as recurrent fever and loss of appetite or energy

c. pain not associated with change in bowel habits (such as diarrhea or constipation)

d. RAP occurring in a child older than 5   years

e. a and b

6. The mother of the patient is extremely anxious and wants to know if the investigations need to be repeated at this time. You tell her which of the following?


a. CBC, ESR, and urinalysis will be repeated

b. no further testing needs to be done

c. KUB radiograph study needs to be done

d. abdominal ultrasonography needs to be done

e. the next step will be to perform an upper gastrointestinal endoscopy (EGD) to “rule out all possibilities”

7. Which of the following is the treatment of choice for the condition described?


a. muscle relaxants

b. tricyclic antidepressants

c. narcotic analgesics

d. nonsteroidal antiinflammatory drugs

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Recurrent Abdominal Pain

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