Stomach Pain for 3 Weeks

[SandIsMyGlitterRN]

Advice to see if I am missing something. Student with abdominal pain for 3 weeks following a diagnosis of flu. No vomiting and no diarrhea. Not a frequent flyer. Cries in pain and because missing class. No distension, soft belly. Bowel sounds present. No radiation of pain. No increase in pain with movement. Having regular BMs. What are we missing?????? I am not trying to diagnose (well.....) but there has to be something that we are missing. Student has been to doc but they are stumped also.

[perc71, BSN, MSN, APRN, NP]

There is not much to go on here without a thorough and comprehensive history and physical exam. 3 weeks of severe abdominal pain. Tamuflu as a culprit is a stretch. I agree with the other posts- the Pediatrician should punt this to GI.

[adjappleton]

Strep. *I know nothing and only aspiring health care professional* but know of kids who've had lingering bad stomach aches with no other symptoms, especially the typical raw/sore throat.

[JenTheSchoolRN, BSN, RN]

14 hours ago, adjappleton said:

Strep. *I know nothing and only aspiring health care professional* but know of kids who've had lingering bad stomach aches with no other symptoms, especially the typical raw/sore throat.

This is true. Though strep test is auto with stomach pain for a majority of the pediatric PCPs in my areas. Had three kids diagnosed with strep this way this year and I always mention it for kid with ongoing stomach pain.

But, yes, GI referral to start. I just had a kid with ongoing stomach pain, nausea be diagnosed with ITP (Immune thrombocytopenic purpura) as well. Finally found on last ED visit due to stomach pain that would just not abate again over a weekend. (Unfortunately, care is supportive, but anti-nausea meds for a couple of days did wonders for this kid).

Next question I have is: emotional health. Is this child also experiencing any new stress? Once the physical is ruled out, this is the next guess for me.

[CanIcallmymom, BSN, RN]

16 hours ago, adjappleton said:

Strep. *I know nothing and only aspiring health care professional* but know of kids who've had lingering bad stomach aches with no other symptoms, especially the typical raw/sore throat.

Good point. I have had multiple friends (ER nurse friends) whose kids had severe abd pain that they thought was appendicitis, ended up being strep! Definitely an idea for an easy rule out.

[HandsOffMySteth]

They should start with a stool guaiac and get a CT I should think. Just sitting around guessing doesn't help.

[SandIsMyGlitterRN, BSN, RN]

Thank you for all of your thoughts. The doc did finally get a stool sample and parents are waiting for results.