Case studies 1 Flashcards
What is a pound?
~0.4536kg
An ounce is 1/16th of a pound
What is a fluid ounce?
28.4 ml
A 6y old boy presents with 12m of abdominal pain. He passes stools 1/week with occasional blood. He is on the 98th weight centile and 50th height centile.
Examination shows small soft masses in the LLQ.
What is the diagnosis?
Constipation +/- impaction
A 6y old boy presents with 12m of abdominal pain. He passes stools 1/week with occasional blood. He is on the 98th weight centile and 50th height centile.
Examination shows small soft masses in the LLQ.
What history would you want to obtain?
- Stool frequency/ consistency/ size/ pain/ blood
- Toilet training and use/ Soiling/ Withholding
- Diet/ appetite/ fluids/ activity/ school routine
A 6y old boy presents with 12m of abdominal pain. He passes stools 1/week with occasional blood. He is on the 98th weight centile and 50th height centile.
Examination shows small soft masses in the LLQ.
What examination would you want to carry out?
- Inspect lower spine and anus
- Check lower limb neurology
- Measurements and centile
- No rectal examination
A 10 week old boy presents with 4 weeks of frequent post feed effortless vomits and distress (back arching and pulling up knees).
Examination showed a soft abdomen with no palpable masses.
Differential diagnosis?
- Gastro-oesophageal reflux (GORD)
- +/- Milk intolerance
- Consider pyloric stenosis
- Consider surgical causes if bilious
A 10 week old boy presents with 4 weeks of frequent post feed effortless vomits and distress (back arching and pulling up knees).
Examination showed a soft abdomen with no palpable masses.
Questions to ask.
- Vomits: Bilious or not/ Volume/ Amount/ Blood
- Feeding: Type/ Volume/ Frequency/ Position
- General: Weight gain+ centiles/Development/ Cough
Management of GORD - feeding advice
- Feed routines (timing/ positioning/ adverse factors)
- Feed volumes (~150ml/kg/day)
- Reassurance (common, resolves, baby thriving)
Management of GORD - medical treatment
- Feed thickeners (carobel/ thick and easy/ gaviscon) sachets
- Milk free feeding (Baby +/- Mum + Dietician!)
- Acid reduction (Ranitidine/ Omeprazole)
- Pro-kinetics (Domperidone)
Management of GORD - surgery
- Uncommon
- Gastrostomy + Fundoplication
When should milk allergy be considered?
- No or poor response to anti-reflux medications
- Aversive feeding
- Personal or family history of atopy
How should children with suspected milk allergy be treated?
These babies merit trial of milk free diet/ hydrolysed feed
2y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day)+ flatus, miserable. Picky eater, all normal diet, formula fed, tried milk free diet- no benefit.
No significant past illness or family history.
Examination; Pale, less subcutaneous fat, muscle wasting, distended abdomen.
Diagnosis?
Coeliac disease
Investigations for coeliac disease
- Coeliac serology
- IgA (needs separate biochem sample)
- Small bowel biopsy (If screen positive)
A 2 week old baby present with a 2 day history of vomiting all feeds. The parents bring in one of his baby grows. Weight is down 30g.
He is unsettled on examination.
What colour is bile?
Bile is green