Beruflich Dokumente
Kultur Dokumente
OF ABDOMINAL PAIN
Aswitha D Boediarso
BKGAI / UK GASTROHEPATOLOGI IDAI JAYA
Abdominal pain :
Common symptom
Lesion :
Intra abdomen
Extra abdomen
Physical examination
Further investigation
work-up,
Childhood Functional
Gastrointestinal Disorders
Rome II Criteria
Vomiting
Abdominal pain
Functional diarrhea
Disorders of defecation
Rasquin-Weber A, et al, Gut 1999
Rome II Criteria
G2.1.
G2.2.
G2.3.
G2.4.
G2.5.
Functional dyspepsia
Irritable bowel syndrome
Functional abdominal pain
Abdominal migraine
Aerophagia
FUNCTIONAL DYSPEPSIA
Children mature enough to provide an
accurate pain history
At least 12 weeks, not to be consecutive,
preceding 12 months
ABDOMINAL MIGRAINE
Midline abdominal pain, two hours to several days,
interventing symptoms-free interval weeks to months
Three or more paroxysmal episodes of intense
Two of following features :
Headache and photophobia during episodes
Family history of migraine
Headache confined to one side, an aura
AEROPHAGIA
At least 12 weeks, not be consecutive,
preceding 12 months
Two or more the following signs and
symptoms
Air swallowing
Abdominal distension due to intraluminal air
Repetitive belching and/or increased flatus
Diagnosis
Gejala
Nyeri
Gejala umum
Defekasi
Dispepsia
fungsional
12 minggu
Abdomen
bagian atas
Mudah kenyang
Kembung
Rasa panas di perut
Tidak ada
hubungan
Sindrom usus
iritabel
12 minggu
Nyeri hilang
dengan
defekasi
Kembung
Keram
Kelainan frekuensi
Kelainan
konsistensi
Lendir dalam tinja
Migren perut
3 atau lebih
episod selama
2 jam atau
lebih, dalam
12 bulan
Paroksismal
Garis tengah
abdomen
Tidak ada
hubungan
Sakit perut
fungsional
12 minggu
Hampir
kontinu
Tidak ada
hubungan
Physical Examination
List 1
APPROACH
List of Alarm Symptoms / Red Flag (history
and physical examination)
Diary
It is wise to not perform invasive test, have a
wait and see attitude with lots of support
Continuing observation and periodic examination
Two line approach which include psychosomatic as
well as medical investigation
Dispepsia
(Nyeri epigastrium, berhubungan
dengan makanan, mual, muntah,
regurgitasi, nyeri dada, kembung,
cepat kenyang)
Gangguan pola
defekasi
(diare/konstipasi)
Nyeri
(gejala tunggal)
Sindrom nyeri
siklik
TANDA BAHAYA
TIDAK
YA
Kelainan fungsional :
1.
2.
3.
4.
DIARE
1.
2.
3.
4.
Dispepsia
1. Serologi H.pylori
1. USG abdomen
2. Barium enema / meal
3. C4 serum
ABDOMINAL PAIN
LIST II
Age
Alarm Symptoms
Red Flag
Laboratorium
blood, urine, fecal,
etc
Early assessment
Time onset, location, charac pain
Associated symptoms
Diseases indicators
The child life style, habit
Home and social environment
ORGANIC
FUNCTIONAL
ABDOMINAL PAIN
FUNCTIONAL
ORGANIC
Surgery
Distended abd
pain prior
vomiting,
bilious vomiting
masses,
peritonitis, etc
G1
Medical
Further
Investigation
related to
suspected organ
G2
G3
G4
G5
No improvement
Medical psycho
Improvement
No alarm Sympyoms
Colaboration with Psychologist