Return to Scenario ListShow Learning Points most relevant to Phase 1:

Chronic abdominal pain in children and adolescents

Clinical Discipline(s)/Organ System(s)
Digestive System, Paediatrics, Psychiatry/Health Psychology
Progress Test Topic(s)
Child health
A 7 year old NZ European boy who has had ill-defined abdominal pain almost daily for 3 months, is seen by his GP. His father thinks he has lost a little weight and is lethargic.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Structure, function and common pathologies of the gastrointestinal tract in infants and children
   - Embryology and fetal development of gut and congenital abnormalities of the gastrointestinal tract
   - Pathogenesis of appendicitis and inflammatory bowel disease
   - Pathogenesis of food allergy/intolerance
Clinical and Communication Skills 
   - Assessment of the child presenting with abdominal pain and assessment of school-aged child with recurrent abdominal pain
   - Examination of the abdomen (including perianal/perineal areas) and eliciting important signs and symptoms (blood in stools, abdominal masses, weight loss, extraintestinal signs such as rashes and joint pains)
   - Features that distinguish organic from functional recurrent abdominal pain
   - Recognise specific macronutrient and micronutrient deficiency states; assess dietary status and history of medication/supplements
   - Assessment of normal growth and development of a child and plotting growth parameters
   - Assessment of anxiety/depressive symptoms
   - Interpretation of laboratory data (urine, blood parameters for chronic disease)
   - If adolescent: HEADSS assessment and interviewing a child without parent/carer
   - Appropriate management of medically unexplained somatic symptoms
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Evaluation of social history (any emotional, school, or family stressors, abuse history)
   - Consent, assent and children's role in discussions and decision-making
Hauora Māori 
   - Awareness of Whānau dynamics (who is/are carers)
   - Understand context of educational inequities for Māori children: potentially relevant to aetiology (e.g. discrimination)
   - Differing risk profiles for Māori (and other populations such as refugee) compared with non-Māori in NZ for disorders relevant to this scenario
   - Ability to discuss the return of any body parts to whānau if requested post-surgery
Population Health 
   - Provision of paediatric surgical and emergency services nationally
   - Age-appropriate immunisation status
Conditions to be considered relating to this scenario
constipation, functional abdominal pain (recurrent idiopathic abdominal pain), abdominal migraine, anxiety/depression, infection (urinary tract infection, giardiasis)
Less common but 'important not to miss'
inflammatory bowel disease, malabsorption, coeliac disease
peptic ulcer disease, pancreatitis, hepatitis, tumours, malrotation, congenital band adhesion and other causes of partial bowel obstruction, gynaecologic problems, cystic fibrosis, food allergy, eating disorder