Child with GI symptoms Flashcards
Key history in child with GI symptoms
Onset, location, quality, intensity, duration, radiation, timing (relation to meals) Other symptoms (constitutional, GI, cardiac, pulmonary, renal, pelvic) Changes in weight Skin rash Bloody/mucoid stools Change in stool color Exacerbating and alleviating factors Hx of prior symptoms Hx of abdominal surgeries Medications Sick contacts Day care Immunizations
Key physical exam in child with GI symptoms
Vital signs Exam for signs of dehydration (BP, heart rate, skin turgor) Heart and lung exams Abdominal exam Rectal exam Pelvic exam (for girls)
1-month-old F has been spitting up milk for last 10 days
+ vomiting episodes have increased in frequency and forcefulness
+ nonbloody, nonbilious emesis
+ episodes occur immediately after breastfeeding
+ stopped gaining weight
Pyloric stenosis Partial duodenal atresia GERD Gastroenteritis Hepatitis UTI Otitis media
Physical exam CBC Electrolytes US - abdomen Barium swallow pH probe Endoscopy AST/ALT/bilirubin/alkaline phosphatase UA, urine culture Tympanocentesis culture
3 yo M with constipation
+ one bowel movement per week since birth despite using stool softeners
+ did not pass meconium until two days after birth
+ poor weight gain
+ FHx of this problem
Hirschsprung's disease Low-fiber diet Anal stenosis Hypothyroidism Lead poisoning
Physical exam Rectal exam Stool exam and culture Barium enema Suction rectal biopsy Anorectal manometry TSH, FT4 CBC Electrolytes Serum lead level
8 month-old F with sudden-onset colicky abdominal pain and vomiting
+ episodes are 20 minutes apart, and she is completely well between episodes
+ had originally had loose stools several hours before pain
+ now her stools are bloody
Intussusception Appendicitis Meckel's diverticulum Volvulus Gastroenteritis Enterocolitis Blunt abdominal trauma
Physical exam Rectal exam, stool for occult blood CBC Electrolytes Contrast enema US - abdomen CT - abdomen
7 yo M with abdominal pain that is generalized, cramping and worse in the morning
+ seemingly less prominent during weekends and holidays
+ missed many school days because of pain
+ growth and development are normal
+ parents are recently divorced
Somatoform disorder Malingering Irritable bowel syndrome Lactose intolerance Child abuse
Physical exam CBC Electrolytes US - abdomen CT - abdomen Amylase, lipase Stool exam
2 month-old M with persistent crying for two weeks
+ episodes subside after passing flatus or eructation (belching)
+ no change in appetite, weight or growth
+ no vomiting, constipation or fever
Colic Formula allergy GERD Lactose intolerance Strangulated hernia Testicular torsion Gastroenteritis
Physical exam
Rectal exam, stool for occult blood
US - abdomen
US - testicles
