I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Friday, 5 June 2015

Functional Abdominal Pain

Functional abdominal pain is mentioned in the higher syllabus for abdominal pain, and not the core syllabus. It is common in children, and some resources suggest it has a non-organic cause in most cases - some don't. Either way, a cause is difficult to elucidate, with a cause identified in <10%. It is important to consider physical and psychological factors. Functional abdominal syndrome is abdominal pain for 25% of the time, with other symptoms.
Apley's law: the further a recurrent abdominal pain is from the umbilicus, the more likely it is to be organic.

40% of 7 year olds have at least one episode of abdominal pain, with peaks in incidence at 5 and 10 years old.

Recurrent pain:  more common in girls than boys
                           more common in children whose parents have GI problems

3 of more episodes of abdominal pain in three months, that affects daily activities. 
Pain not associated with eating, loss of daily functioning, no other disorder

There is no clear idea what causes recurrent abdominal pain. The biophysical model of disease suggests it's a response to biological factors, family and school interactions, family environment and critical life events. 
It is thought, by Rome III, there are three main categories of functional abdominal pain:
Duodenal Ulcers
Abdominal Migraine
Irritable Bowel Syndrome

Duodenal Ulcers or Functional Dyspepsia: 
Consider in epigastric pain that causes night time waking. Treat by giving PPIs. Test for and treat H Pylori. If symptoms do not respond, then get an endoscopy - if the endoscopy is normal, consider functional dyspepsia.

Irritable Bowel Syndrome
Intestinal dysmotility. Family history is common, and the infection may follow a GI infection. You normally get abdominal pain that is worse before defecation - and relieved by defacation. It can be helpeful to say to children that sometimes the insides of the intestine become so sensitive that some children can feel the food going round the bends. 
Peppermint oil may be helpful. 
Avoiding sorbitol can be helpful, and increasing intake of oats and linseed can help. 

Abdominal Migraine
Abdominal migraine is associated with travel sickness. This may be associated with a headache, but in some children the abdominal pain predominates. The pain is normally midline associated with vomiting and pallor. There is normally a history of migraine. 
Pizotifen may be helpful. 

Make sure you differentiate between serious and dangerous diagnoses. Serious is a disruption to schooling and life. Dangerous is life threatening. 

- Urine culture and microscopy
- FBC, ESR, CRP, LFTs, U&E, Coeliac
- Stool microsccopy 
- Abdominal USS to exclude gall stones and PUJ obstruction
- Pain and life event diary

Red Flags
Unexplained fever
Weight loss and poor growth
Joint problems, rashes
Pain causing waking, referred to back or shoulders
Urinary symptoms, perianal disease, PR blood 
Age under 5 




  1. Very interesting blog. Alot of blogs I see these days don't really provide anything that I'm interested in, but I'm most definately interested in this one. Just thought that I would post and let you know picbear

  2. I'm 15 years old. I was born with HIV my mother passed away because of the HIV infection And I regret why i never met Dr Itua he could have cured my mum for me because as a single mother it was very hard for my mother I came across Dr itua healing words online about how he cure different disease in different races diseases like HIV/Aids Herpes,Parkison,Asthma,Autism,Copd,Epilepsy,Shingles,Cold Sore,Infertility, Chronic Fatigues Syndrome,Fibromyalgia,Love Spell,Prostate Cancer,Lung Cancer,Glaucoma.,psoriasis,Cirrhosis of Liver, Cataracts,Macular degeneration, Infectious mononucleosis.,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,psoriasis,
    Dementia.,Tach Disease,Breast Cancer,Blood Cancer,Colo-Rectal Cancer,Love Spell,Chronic Diarrhea,Ataxia,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
    Syndrome Fibrodysplasia Ossificans ProgresSclerosis,Weak Erection,Breast Enlargment,Penis Enlargment,Hpv,measles, tetanus, whooping cough, tuberculosis, polio and diphtheria)Diabetes Hepatitis even Cancer I was so excited but frighten at same time because I haven't come across such thing article online then I contacted Dr Itua on Mail drituaherbalcenter@gmail.com/ . I also chat with him on what's app +2348149277967 he tells me how it works then I tell him I want to proceed I paid him so swiftly Colorado post office I receive my herbal medicine within 4/5 working days he gave me guild lines to follow and here am I living healthy again can imagine how god use men to manifest his works am I writing in all articles online to spread the god work of Dr Itua Herbal Medicine,He's a Great Man.

  3. Positive site. where did u come up with the information on this posting?I have read a few of the articles on your website now. and I really like your style. Thanks a million and please keep up the effective work.Jogos online
    friv free Games
    play Games friv 2020

  4. This is a great inspiring article.I am pretty much pleased with your good work.You put really very helpful information. Keep it up. Keep blogging. Looking to reading your next post. Click to visit game. sims 4 skill cheats