Makindo Medical Notes

🩺 Chronic abdominal pain is defined as abdominal pain lasting >3 months. It is a common presentation in primary care and gastroenterology, with causes ranging from benign functional disorders to serious organic disease. A structured approach is essential to avoid missing red-flag conditions while avoiding unnecessary over-investigation.

📖 Introduction

• Chronic pain may be constant or intermittent, localised or diffuse.
• Functional GI disorders (IBS, functional dyspepsia) are common in the UK and account for most cases.
• Organic causes must always be excluded, particularly in patients with red flags 🚩 (weight loss, anaemia, GI bleeding, family history of GI cancer).
• A biopsychosocial approach is often required, addressing medical and psychological contributors.

⚡ Causes of Chronic Abdominal Pain

🧾 History & Examination

• Pain characteristics: site, radiation, relation to food, nocturnal pain, severity, pattern.
• Associated symptoms: nausea, vomiting, diarrhoea, constipation, bloating, weight loss, fever, jaundice.
• Red flags 🚩: GI bleeding, anaemia, persistent vomiting, family history of GI cancer, night pain.
• Examination: abdominal mass, hepatosplenomegaly, tenderness, scars, hernias, rectal exam.

🔬 Investigations

• Baseline bloods: FBC (anaemia), U&E, LFTs, CRP/ESR (inflammation), amylase/lipase, coeliac screen.
• Stool tests: faecal calprotectin (IBD vs IBS), stool cultures, FIT (faecal immunochemical test) for bowel cancer screening.
• Imaging: ultrasound (gallstones, masses), CT abdomen (tumours, pancreatitis, diverticular disease), MRI (biliary/pancreatic pathology, pelvis).
• Endoscopy: OGD (upper GI), colonoscopy (lower GI) if red flags or persistent symptoms.
• Special tests: H. pylori breath test, capsule endoscopy, gynaecological ultrasound.

💊 Management

• Treat underlying cause: – IBD → mesalazine, steroids, biologics. – Coeliac disease → gluten-free diet. – Gallstones → cholecystectomy if symptomatic. – Peptic ulcer disease → H. pylori eradication, PPIs. – Chronic pancreatitis → enzyme replacement, analgesia.
• Functional disorders (IBS, dyspepsia): – Dietary modification (low FODMAP diet, fibre balance). – Antispasmodics, PPIs, laxatives/antidiarrhoeals as appropriate. – Psychological support: CBT, stress reduction.
• Supportive care: – Adequate analgesia (avoid long-term opioids 🚫). – Nutrition support (dietitian input if weight loss/malabsorption). – Multidisciplinary input if complex (GI, gynae, pain team, psychology).

📚 Key Learning Points

• Chronic abdominal pain is common and often functional, but red flags must always be excluded.
• A systematic approach covering GI, hepatobiliary, renal, gynae, and vascular causes is essential.
• Investigations should be guided by history and risk profile — avoid unnecessary over-testing.
• Management requires both cause-specific treatment and holistic supportive care.