Case Studies

Question 1

A 3m child who is vomiting and unsettled comes in. He weighs 11lbs and usually takes a 7oz feed 6 times a day however he always seems hungry and unsettled after feeding.

What does he weigh?
What are his feed volumes?
What advice do you have for the parents?

Answer 1

Weighs 5kg
210ml 6xday
1260m/day
Advise to reduce to 120-140ml (4-5oz) per feed

Question 2

A 6ynold boy presents with 12m history of abdominal pain, passes stool 1/wk with occasional blood. He is 98th ventile and 50th height centile. Small soft masses in LLQ

Diagnosis?
Additional features of the history/examination?
Management?

Answer 2

Constipation +/- impaction
History:
stool frequency/consistency/size/pain/blood
Toilet training and use, soiling, withholding
Diet, appetite, fluids, activity, school routine
Exam:
Inspect lower spine, anus
Check lower limb neurology
Measurements and centiles
No rectal exam
Management:
Treat early, softeners, stimulants, increase fluids, fruit veg fibre, reduce milk/sweets, toilet routine and comfort, praise and star charts, watch for “diarrhoea”

Question 3

10w boy presents with 4 weeks of post feed effortless vomits and distress. Soft abdomen with no palpable masses

Diagnosis and differential?
Other questions?
Management and investigations?

Answer 3

Diagnosis and differential: GORD, +/- milk intolerance, consider pyloric stenosis and surgical causes of bilious
Other questions:
Vomits eg bilious or not, volume, amount, blood
Feeding eg type, volume, frequency, position
General eg weight gain, centiles, development, cough