Chronic and recurrent abdominal pain: Viva

Branch 1: History and distinguishing functional from organic pain

The candidate should begin by acknowledging the parents' worry and then take a structured history rather than immediately ordering tests. Characterise the pain by site, timing, and its relationship to meals, defecation, and activity, and note that poorly localised periumbilical pain in a well child is typical of a functional disorder. The key task is to screen actively for alarm features: weight loss or growth faltering, gastrointestinal bleeding, night waking with pain, dysphagia, fever, joint or mouth symptoms, and a family history of coeliac disease or inflammatory bowel disease. ^[2]

A strong candidate gives equal weight to the psychosocial history, asking about school, sleep, mood, anxiety, and how the family responds to the pain, and frames these questions as routine so the family does not feel accused. If the history is typical, growth is normal, and no alarm features are present, the candidate should be prepared to make a positive functional diagnosis rather than treat it as a diagnosis of exclusion. Recurrent abdominal pain that eases at weekends and on holidays supports a functional origin. ^[1]