Abdominal Pain - Surgery - Paediatric CPC

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Exclusions

• children presenting with any of the following, refer to paediatric medicine or gastroenterology prior to surgical involvement:
  • abdominal pain more than two weeks duration
  • abdominal pain with concerning features such as:
    • fever
    • rash
    • joint pain
    • mouth ulcers
    • dysphagia
    • faltering growth
    • persistent vomiting
    • unintentional weight loss
  • recurrent/chronic abdominal pain without concerning features

Triage categories

Category 1 (appointment clinically indicated within 30 days)

• single episode of bilious (green) vomiting with delayed presentation, contact paediatric surgery registrar on-call to discuss your concerns prior to referral
• recalcitrant abdominal symptoms despite assessment and management by paediatric medicine or gastroenterology
• significant rectal bleeding, contact paediatric surgery registrar on-call to discuss your concerns prior to referral
• suspected malignancy, contact paediatric surgery registrar on-call to discuss your concerns prior to referral
• previous abdominal surgery with ongoing abdominal pain

Category 2 (appointment clinically indicated within 90 days)

• nil

Category 3 (appointment clinically indicated within 365 days)

• nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

• past medical/surgical/psychosocial/birth/developmental/immunisation history, surgical history especially relevant if previous abdominal surgery
• family history of autoimmune disease, inflammatory bowel disease, immunodeficiency syndromes
• medications and allergies
• presenting symptoms including:
  • dates and frequency of symptoms
  • duration and severity of episodes
  • treatment trialed and response
  • current management regime including medications and allied health input
  • medical specialist involvement, if previous medical consultation completed
• quality of life concerns including missed work/school/extracurricular activities as a result
• menstrual history, if relevant
• sexual history, if relevant
• toileting history including stool chart if relevant
• abdominal examination including testes, findings
• pathology if done:
  • complete blood examination (CBE)
  • electrolytes, urea, creatinine (EUC)
  • liver function tests (LFTs)
  • lipase
  • c-reactive protein (CRP)
• relevant diagnostic/imaging reports if done, including location of company and accession number
  • abdominal ultrasound (US)
  • abdominal x-ray

Additional information to assist triage categorisation

• in sexually active patients, please exclude a sexually transmitted infection (STI)
• lipase and/or H Pylori urea breath test, positive serology does not indicate active infection

Clinical resources

• The Royal Children’s Hospital Melbourne – Clinical Practice Guidelines: Abdominal Pain – Chronic

Consumer resources

• The Royal Children’s Hospital Melbourne – Fact Sheets: Abdominal Pain
• The Sydney Children’s Hospital – Fact Sheets: Abdominal pain and stomach ache

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

• full name, including aliases
• date of birth
• residential and postal address
• telephone contact number/s – home, mobile and alternative
• Medicare number, where eligible
• name of the parent or caregiver, if appropriate
• preferred language and interpreter requirements
• identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

• impact on employment
• impact on education
• impact on home
• impact on activities of daily living
• impact on ability to care for others
• impact on personal frailty or safety
• identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery, where surgery is a likely intervention.
• Choice to be treated as a public or private patient.
• Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.