3) Atopic gastro enteropathy – recurrent abdominal pain, diarrhea, and vomiting in children with asthma, GIT symptoms usually predate asthma
4) PFAPA Syndrome – See under fever.
5) Non-Alcoholic Fatty Liver Disease or Non-Alcoholic SteatoHepatitis (NASH) – malaise, fatigue, vague recurrent abdominal pain, liver disease is progressive unless managed by weight reduction and treatment of hypertriglyceridemia
6) Abdominal migraine – at least 3 or more attacks within the previous 1 yr comprising: a) acute, severe periumbilical or midline abdominal pain lasting 2 hr to several days with asymptomatic intervals lasting weeks to months b) pain is associated with 2 or more of the following – anorexia, nausea, vomiting, headache, photophobia, pallor, family history of migraine, unilateral headache, aura c) pain is disabling d) Remissions lasts several weeks to months when the child is fully healthy e) no evidence for inflammatory, anatomic, metabolic, neoplastic process to explain the symptoms, Tx – pizotifen, propranolol, cyproheptadine,
7) Functional Abdominal Pain Syndrome – FAPS – usually school-aged or adolescent, abdominal pain, pain expressed in emotional terms, at least continued for 6 months, constant or nearly constant abdominal pain or at least very frequently recurring pain, pain unrelated to meals, defecation, urination, sex, menses, absence of red flags, interference with daily activities common, psychological problems like unusual parental dependence, anxiety, depression, perfectionism, parental perception of the child as special (only child, male child in a family of girls, female child in a family male, youngest child, eldest child), parents anxious, overprotective, authoritarian, preoccupied with the child
8) Functional dyspepsia – following symptoms for at least 12 weeks within the last 1 yr, persistent or recurrent upper abdominal area pain or discomfort above the umbilicus, no evidence for possible organic disease including UGIE (no red flags), no evidence for IBS
9) IBS – following symptoms for at least 12 weeks within the last 1 yr, abdominal pain or discomfort that has at least 2 of following 3 characteristics – relieved by defecation, onset associated with a change of stool frequency, onset associated with a change in stool appearance, no evidence of following – no structural or metabolic abnormalities to explain the symptoms (that is no red flags)
10) IBS is also suggested by the following symptoms – abnormal stool frequency of either > 3 bowel movements/day OR < 3 bowel movements/week, abnormal stool form (lumpy, hard, lose, watery), abnormal stool passage (straining, urgency, sense of incomplete evacuation), the passage of mucus with stools,. Abdominal distension
11) Fod allergy – abdominal pain, vomiting, diarrhea, recurrent episodes, symptoms after ingestion of the suspected allergen (Children’s allergens : cow’s milk, hen’s eggs, pea nuts, tree nuts, seasame seeds, wheat and soy allergy. Adults : shellfish, fish, pea nuts, tree nuts ), allergic response consistent, consistent response for avoidance of the allergen, positive food challenges, allergic reactions in other organs like skin (urticaria, flushing, angioedema, flare ups or worsening of eczema), respiratory (asthma, rhinitis, stridor), cardiovascular (anaphylaxis), Mx – of the clinical situation, avoidance of the suspected food allergen, dietitian consultation when multiple food allergies present (wrong selfcare for presumed multiple food allegies can cause dietary defiiciencies, rickets, IDA, failure to thrive, impaired growth, osteoporosis), advice on selfcare with self adminsitred adrenaline, look for multiple food allergies, avoidance of vaccines containing the preseumed allergen (influenza vaccine in egg allergy), allergy specialist referral for allergic immunotherapy, oral desensitization, monoclonal anti-IgE.