Initial work-up

• History and physical exam - rule out neurological cause
• Urinalysis
• FBE with diff, ESR or CRP
• LFTs
• Amylase or lipase
• U&Es

If obstruction is a concern -

• Abdominal or renal ultrasound

Recommended pre-referral treatment

• H₂ receptor drug (eg.Ranitidine - Zantac 3mg/kg dose BD orally. Syrup available).
• Maximum 150mg

When to refer

• Depending on results of initial evaluation, refer for further evaluation.

Resources

• Make a referral:Specialist Clinics
• Contacts
• RCH Primary Care Liaison (GP website)
• Kids Health Info (Parent information website)  

References and more reading

• Paediatric Handbook (2009). Gastrointestinal Conditions, Chapter 24 (pp369-389) Mark Oliver and Lionel Lubitz. Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

Guideline developed by the RCH Department of Gastroenterology in consultation with a GP Review Group. Many thanks to the GPs involved in the review.  First published Jan  2008. Reviewed August 2009. 
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