Severe Abdominal Pain

A detailed history is a key to the diagnosis. For example, I would suspect constipation if a child has infrequent bowel movement, excessive straining, passing hard stools, incomplete defeacation sensation, faecal incontinence, abdominal pain during and shortly after mealtime. A child may have fructose intolerance if he or she experiences abdominal pain and diarrhea after consuming high fructose containing food. A child with coeliac disease may have bowel symptoms after consuming wheat and gluten containing product.

Patient with new diagnosis of inflammatory bowel disease may experience weight loss, severe lethargy, joint pain in addition to the bowel symptoms.

After taking a full history, I would then carry out common baseline abdominal pain investigations. These include:

• Abdominal ultrasound scan
  • to check for organs in the abdominal cavity such as pancreas, gall bladder, kidney, pancreas, bowel, spleen
• Stool tests
  • Calprotectin-to check for bowel inflammation such as inflammatory bowel disease
  • Helicobacter Pylori antigen-to check for helicobacter pylori gastritis
• Blood tests
  • Anti-TTG IgA-to check for Coeliac disease
  • Amylase-to check for pancreatitis
  • ESR and CRP inflammatory markers-to check for inflammatory bowel disease
  • Liver and kidney function tests-to check liver and kidney health
• Skin prick testing
  • To check for immediate food allergies such as milk, egg, wheat and soya

I may consider hydrogen breath tests to check for sucrose, lactose, fructose intolerance and small intestinal bacterial overgrowth.

I may consider abdominal x-ray to check for occult faecal loading.

I may consider excluding food group in your child’s diet such as dairy free diet.

By doing the above investigations, it is likely that we will be able uncovering the cause of your child’s abdominal pain.