symptoms or signs may suggest a higher likelihood of organic disease and is an indication for the performance of diagnostic tests, whereas in the absence of alarm symptoms, diagnostic studies are unlikely to have a significant yield of organic disease’. Alarm symptoms mentioned are weight loss, gastrointestinal bleeding, persistent fever, chronic severe diarrhea and vomiting. In this study associated symptoms were present in 33 of the 60 patients. Organic disease was diagnosed in 47 patients (78.3%). In this diagnosed group only 24 patients had associated or alarm symptoms which accounted for only 49.6%. These were vomiting, fever, loss of weight, jaundice, loss of appetite and urinary symptoms. This is also in contrast to the literature. This study has not denied investigations based on the presence or absence of alarm symptoms.
We carried out a prospective service evaluation on the quality of pain control after preoperative TAP block in 100 children undergoing abdominal surgery. Prospective service evaluations are well-established quality assessment instruments in the UK’s National Health Service. This study was approved and registered with Birmingham Children’s Hospital’s clinical governance department (reg. BCH AN 86/2010) and con- ducted as a prospective evaluation of practice and outcome in line with UK legislation. The results were anonymized and do not allow identification of individual patients. The hospital’s clinical governance department advised that publication of the results does not require patient or parental consent.
concluded that limited detection rates, added costs and the inconvenienceof these tests made the routine use of endoscopy,radiography, thyroid function tests, fecal ova and parasite determination and the lactulose hydrogen breath test questionable in the diagnostic evaluation of established IBS patients. In accordance with these results, Tolliver et al (129) performed fecal ova and parasite determinations in 196 patients with a possible diagnosis of IBS, and found no evidence of infection in any of them. In the same study, complete blood cell count, sedimentation rate, serum chemistries, thyroid profile and urinalysis were normal or yielded no useful clinical information. A study designed to investigate the prevalence of elevated antiendomysial antibody titers in children with recurrent abdominalpain compared with healthy children found no association between abdominalpain and celiac disease (130) . The study showed that 1% of patients in each group had positive celiac disease antibodies. An adult investigation studied serum antibody testing for celiac disease in patients with IBS symptoms and a control group, followed by upper endoscopy in positive cases. The study revealed that 4.6% of patients in the group with possible IBS had positive antibodies in comparison with 0.67% in the control group, suggesting that testing for celiac disease may be one of the few cost-effective evaluations in patients with IBS
In recent years most adult trauma centers have inte- grated the FAST examination into an assessment proto- col of blunt abdominal injury. However, pediatric trauma centers have responded tepidly to the incorpor- ation of this technology. We believe that the main rea- son for the low adoption of FAST in the evaluation of children is the rare occurrence of unstable children with IAI. In adults FAST has almost eliminated the need for deep peritoneal lavage (DPL) that was used extensively in the past. Although rarely used DPL have the advan- tage of not only detecting free fluid in the abdominal cavity but also to elaborate on its quality (blood, bowel content, urine etc.).
The subcommittee examined the diagnostic and thera- peutic value of a medical and psychological history, di- agnostic tests, and pharmacologic and behavioral ther- apy. The presence of alarm symptoms or signs (such as weight loss, gastrointestinal bleeding, persistent fever, chronic severe diarrhea, and significant vomiting) is as- sociated with a higher prevalence of organic disease. There was insufficient evidence to state that the nature of the abdominalpain or the presence of associated symp- toms (such as anorexia, nausea, headache, and joint pain) can discriminate between functional and organic disor- ders. Although children with chronicabdominalpain and their parents are more often anxious or depressed, the presence of anxiety, depression, behavior problems, or recent negative life events does not distinguish be- tween functional and organic abdominalpain. Most chil- dren who are brought to the primary care physician’s office for chronicabdominalpain are unlikely to require diagnostic testing. Pediatric studies of therapeutic inter- ventions were examined and found to be limited or inconclusive. Pediatrics 2005;115:e370–e381. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2004-2523; abdominalpain, functional bowel disorders, irritable bowel syn- drome, dyspepsia, stress, anxiety, depression.
In early 70s chronicabdominalpain was classified as organic (10%) and psychogenic (90%). However in 80s, a revised classification was adopted. Chronicabdominalpain was classified as organic (20%), dysfunctional (75%) and of psychiatric pathology (5%). Rome III (2006) divides Functional Gastro Intestinal Disorders in pediatrics into Type G for neonates and toddlers and Type H for older children and adolescents. Rome III classification reduces time duration to 2 months. The validity and reliability of Rome III criteria in diagnosing pediatric Functional Gastro Intestinal Disorders, however is yet to be fully validated, through it is clinically sound. One recent Sri Lankan study attempted this validation and found it to be useful 9 .
It is not surprising that a mind-body therapy, such as guided imagery, is effective for RAP as functional gastroin- testinal disorders are theorized to be the result of a dysreg- ulation of the brain-gut neuroenteric system, much like anovulatory bleeding is a dysregulation of the hypotha- lamic-pitutary-ovarian system . Our study clearly shows that the response to guided imagery in this group of children with RAP was rapid, sustained, clinically effec- tive and not associated with any apparent side effects. This intervention could easily be initiated at the first evalua- tion for abdominalpain then continued while completing any diagnostic work up. This would likely have benefits to the child whether or not they had an organic cause for their abdominalpain as it is an effective tool for coping with pain. Guided imagery could be presented to the patient and family as 'imagination therapy' and be done by the pediatrician, psychologist, social worker, child-life therapist, or nurse trained in guided imagery. By using this type of therapy early in the course of the evaluation and treatment of RAP it is possible, as in the adult studies [30,59], to reduce not only the number of days with pain with subsequent return to regular activities, but also reduce health care costs by decreasing the use of medical services.
ABSTRACT. Children and adolescents with chronicabdominalpain pose unique challenges to their caregiv- ers. Affected children and their families experience dis- tress and anxiety that can interfere with their ability to perform regular daily activities. Although chronic ab- dominal pain in children is usually attributable to a functional disorder rather than organic disease, numer- ous misconceptions, insufficient knowledge among health care professionals, and inadequate application of knowledge may contribute to a lack of effective manage- ment. This clinical report accompanies a technical report (see page e370 in this issue) on childhood chronic abdom- inal pain and provides guidance for the clinician in the evaluation and treatment of children with chronic ab- dominal pain. The recommendations are based on the evidence reviewed in the technical report and on consen- sus achieved among subcommittee members. Pediatrics 2005;115:812–815; abdominalpain, irritable bowel syn- drome, functional bowel disorders.
Recent advances on the role of 5-HT in the enteric ner- vous systems and its relationship to intestinal visceral hyperalgesia have contributed significantly to the under- standing of abdominalpain and IBS in adults. This increased knowledge has helped shift the paradigm that these disorders are exclusively behavioral in nature and that pathophysiologic disturbances at the cellular level exist. To date, the consideration of inflammation and intestinal pain has been traditionally reserved for condi- tions such as Crohn ’ s disease and ulcerative colitis. The preliminary findings presented in this manuscript indi- cate that similar relationships may exist in the pediatric population with chronicabdominalpain of unknown origin. Future research is needed in order to uncover the associated causes of abdominalpain without inflam- matory pathology in pediatric patients. Novel medical treatments can arise by unveiling the role of mast cells and 5-HT in the pathophysiology of chronicabdominalpain of unknown origin in children.
Many children seek medical advice for Recurrent AbdominalPain. Recurrent AbdominalPain hinders the daily activities of 4% to 25% of school going children. It seems to be a benign problem, but morbidities associated with RAP include poor school attendance, hospital admission and laparotomies, symptoms sometimes continue to adulthood. [1,2] Social withdrawal, poor physical abilities, school absentees occur in 10% to 15% of school children due to recurrent abdominalpain on regular basis that result in increased health care visits and has poor effect on child's well being. [3,4] The burden of disease is under scored as 1 out of 3 experience chronicabdominalpain for minimum of 5 years.  Irritable bowel syndrome, a functional gastro-intestinal disorder is one of adulthood complication of childhood RAP.  Acidic environment of stomach is site for growth of H.Pylori, a pathogenic Gram-negative spiral bacillus. It is a leading cause of chronic gastritis, peptic ulcers, non-ulcer dyspepsia, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. 50% of the total world population is infected with H. pylori according one estimate. Developing World currently is on hit list of H.pylori.  Longstanding exposure to H. pylori is usually asymptomatic but can lead to chronic gastritis in children and sometimes peptic
Our center’s findings with respect to the overall intracenter frequency of celiac testing in children with functional abdominalpain is supported by a previous study identifying that 57% of 122 children underwent celiac serologic testing when being evaluated at a tertiary care medical center for abdominalpain . However, this study by Dhroove, et al. was limited in that children with chronic diarrhea, weight loss, and abdominalpain in particular locations were excluded. Though abdominalpain in certain locations and weight loss are considered “red flags” when evaluating a child with chronic abdom- inal pain , children and adults with these symptoms may still have a functional gastrointestinal disorder, particularly given a negative evaluation for an organic eti- ology [11-14]. As such, children with symptoms associated with celiac disease and functional gastrointestinal disor- ders were excluded in the Dhroove study. Potentially in concordance with these limitations, none of the studied children were subsequently found to have celiac disease, leading to an estimated prevalence of celiac disease in their population of chronicabdominalpain below that of Table 2 Demographic characteristics and gastrointestinal
Objective: Intermittent gastric volvulus is a rare dis- ease that requires high index of suspicion for diagno- sis and treatment. The incidence and prevalence is unknown, may be due to under reporting or under diagnosis. Gastric volvulus may be transient produc- ing few symptoms. The Borchardt’s Triad may be present only during an acute presentation. Common symptoms may mislead to diagnose a nonsurgical disease if an evaluation is not done, keeping in mind a possibility of gastric volvulus, even if a UGI scopy is normal. Cases may be submerged in the community being undiagnosed. Case Series: CASE 1: 21 yrs old male with intermittent abdominalpain for 1(1/2) yrs with marfanoid habitus, MVP and a normal UGI scopy. BMS revealed an Organo-Axial Volvulus and ligament laxity per-operatively. CASE 2: 65 yrs old diabetic female with vomiting and abdominalpain for 3 months and left sided pneumonitis. UGI scopy showed twisted gastric folds immediately below OGJ and inability to visualise antrum. BMS revealed mixed volvulus with paraesophageal herniation of distal sto- mach. Per-operatively there was laxity of ligaments with omental content alone within the diaphragmatic rent. Posterior retrocolic sub-mucosal gastrojeju- nostomy(pexy) was done for all cases. Conclusion: Gastric volvulus should be thought of in a case of chronic intermittent abdominalpain with normal baseline evaluation. A Chest X-ray and BMS should be done, at the time of symptoms.
Given their safety proﬁle, probiotics seem to be an attractive therapeutic option for chronicabdominalpain. However, few data are available from children with this condition, and differ- ences in study design and the use of nonvalidated and differing end points complicate the interpretation of the re- sults. LGG was evaluated in 2 different randomized, placebo-controlled trials. In 1 trial, LGG was administered for 6 weeks to 50 children with IBS. The au- thors did not ﬁnd an increased beneﬁt of the probiotic over the placebo, prob- ably because of a high response rate in the latter group. 15 LGG was subse-
MAY-JUNE 2016, VOL-3/24 www.srjis.com Page 2335 endings,ischemia.Chronic abdominalpain due to organic causes such as –adhesions,biliary cause ,appendicular pathology,malignancy.Functional causes –irritable bowel disease,motility disorder,abdominal wall spasmodic pain mistaken as visceral pain.Almost all chronicabdominalpain are subjected to multiple investigation but did not reach a diagnosis..So evolution of laparoscopy came in role.Laparoscopy means greek lapro is flank, the skopin is to examine. Laparoscopy is now important intermediate tool for cases refusing for exploratory laparotomy .laparoscopy can be used as therapeutic and diagnostic tool for chronicabdominal pain.Diagnostic laparoscopy (6) helps in assessment of chronicabdominalpain by evaluating liver disease,evaluation of unknown ascites,staging malignancy,fever of unknown origin,second look surgery,abdominal penetrating injuries in trauma.Therapeutic laparoscopy is indicated in appendectomy ,gall bladder surgery,lysis of adhesion,pelviscopy,in hernia cases ,malignancy depending on experience of surgeon.first laparoscopy was performed in 1901,on dog by George kellig of Dresden (7) . This is a single centric prospective observational study of 63 cases in lokmanya tilak medical college,sion Mumbai from dec 2013 - nov 2015.Cases included - age >18 yrs having chronicabdominalpain not responding to treatment,willing to participate,cases excluded from the study - acute cases,obstruction,critically ill,decompensated cardiopulmonary failure ,pregnant ,diaphragmatic hernia,peritonitis .The cases of chronicabdominalpain were subjected to all investigation-Hb,cbc,lft,rft,chest x ray,if required ct scan .As a protocol all cases detail history of medical and surgical intervention was recorded on proforma.All cases were subjected to laparoscopy and as a standard general anaesthesia was given.Pneumoperitoneum was created with veress needle,2 to 3 trocer were introduced in abdomen for manuplation of organs and biopsy and intervention ,0/30 degree laparoscope was used to evaluate abdomen,as per intra operative finding ,therapeutic or diagnostic method was implied,port closure was done by vicryl 2-0,skin by ethilon 2-0 as a standard for all 63 cases.
On the day of admission, because of lack of a clear diagnosis, referral to psychology and neurology was considered for evaluation of possible abdominal migraine, conversion disorder, or malingering. The morning of admission, the patient became highly agitated and altered in the ED. He was admitted to the pediatrics service after being given valproic acid and diphenhydramine. Repeat KUB at this time was unremarkable. On the evening of admission he was found to be anuric, increasingly altered, hypotensive, tachycardic, and tachypneic. Multiple laboratory derangements were noted. He was moved to the ICU where he had an episode of frank hematemesis. At this point, a surgical consultation was ordered. Repeat KUB showed a small bowel obstruction and possible pneumoperitoneum. The patient was then taken to the operating room for an emergent exploratory laparotomy. Upon entering the patient’s abdomen, the surgical team encountered grossly necrotic bowel (Fig 1A). Further inspection revealed a large left PDH defect (Fig 1B), which contained the midgut, cecum, appendix, and a portion of the right colon. The herniated bowel was also found to be
Resective procedures are Distal pancreatectomy ( body and tail of pancreas resected), Whipples procedure (head and uncinate process resected),Subtotal pancreatectomy where by a small rim of pancreas retained along the inner curvature of duodenum, and total pancreatectomy. After total pancreatectomy brittle diabetes can occur. In chronic pancreatitis inflammatory process in head of pancreas decides the symptoms and further progression of the disease in rest of the gland. Hence after resection of pancreatic head, pain relief was achieved in more than 70to80%of patients.
In this study, adhesions were found in 21 patients in which 20 patients were females. 8 out of 21 patients belonged to the 36-45 years age group. Most of the female patients had previous abdominal surgeries such as lower segment caesarean section and or sterilization. Adhesions were most commonly found adhering to the scar over the anterior abdominal wall. All the 21 patients with adhesions were treated with laparoscopic adhesiolysis in the same sitting without any complications.
Low back pain patients who met the inclusion criteria are selected for group-A and the same number of subjects with same age group without low back pain is selected for group-B.For all the patients two base line measurements of gait parameters with and without abdominal draw- ing in maneuver are assessed with the help of Biodex gait trainer. Auditory biofeedback device is used to maintain the abdominal drawing in maneuver while measuring the abdominal drawing in maneuver procedure. The base line pain measurements for Group A subjects are ascertained by administering the Revised Oswestry low back pain questionnaire. After documenting the base line measure- ments of all the subjects, the abdominal drawing in ma- neuver is demonstrated as the subjects are asked to lie in the supine crook-lying position on the treatment table with their knees bent to 90º, feet flat on the table, and arms be- sides the trunk. The participants were then instructed to perform an abdominal drawing in, then push through the heels to lift their hips into the air while maintaining straight alignment of the knees, hips, and shoulders and maintain this for 10 seconds and then to lower their hips back. Fur- ther instructed them to continue this for 10 times. Subjects performed this exercise for 10 times 3 sets per day for four weeks.
For the analysis of genotyping data, the threshold for Quality value, which influences the allele call was set to 100 (Additional file 2: Table S1). Chi-square tests were performed to study the associations of BDNF SNP with categorical measures of sleep quality (poor sleep versus good sleep) and pain groups (CAP versus healthy control). The BDNF Met allele has previously been associated and implicated in various behavioral and cognitive processes [20-22]. In order to assess the associations of the Met allele with the sleep, pain and gene expression data, heterozygous and homozygous Met genotypes were grouped together into a Met carrier group (Table 3) for comparison with the homozygous Val genotype (or non-Met carrier group) as is typically done in the study of these alleles due to the low frequency of the homozy- gous Met genotype [20,22].