CLIPP 27

Question 1

most common cause of abd pain in school-age kids

Answer 1

functional - is chronic, recurrent, usually nonspecific and not life threatening; kids w/ this often have somatic complaints

Question 2

categorization of functional abd pain

Answer 2

functional dyspepsia, abdominal migraine, irritable bowel syndrome, functional abdominal pain syndrome

Question 3

diagnosis of functional abd pain

Answer 3

no alarming signs or sx, normal physical exam, stool negative for occult blood

Question 4

treatment of abd pain

Answer 4

reassurance, possibly psychological referral

Question 5

concerning signs/sx in pediatric abd pain that warrant more workup

Answer 5

Involuntary weight loss
Deceleration of linear growth
Gastrointestinal blood loss
Significant vomiting
Chronic severe diarrhea
Persistent right upper or right lower quadrant pain
Unexplained fever
Family history of inflammatory bowel disease
Abnormal or unexplained physical findings

Question 6

slowing of weight gain, or weight loss

Answer 6

can be first sign that is indicative of chronic disease

Question 7

drop in height velocity

Answer 7

suggest long standing illness

Question 8

heel tap tenderness

Answer 8

peritoneal sign that may be elicited by firmly tapping the heel. peritoneal signs can also be elicited by bumping into the gurney, or asking the patient to jump up and down

Question 9

rectal exams in pediatrics aids in the dx of

Answer 9

GI bleed, intussusception, rectal abscess, impaction

Question 10

stool guaiac test

Answer 10

confirms presence of blood in stool

Question 11

classic celiac dz presentation

Answer 11

between 6 and 24 months of age with chronic abdominal pain, abdominal distention, diarrhea, anorexia, vomiting, and poor weight gain.
The presentation is quite variable, though, and the diagnosis of celiac disease is often delayed due to the lack of classic symptoms.
Celiac disease can present with occult blood loss leading to anemia, but gross blood in the stool would be unusual.
Diarrhea is commonly seen in celiac disease.
This is an important diagnosis to exclude.

Question 12

common bugs in GI bacterial infection

Answer 12

yersina, salmonella, shigella, campy - TYPIVALLY will present as acute process

Question 13

most common intestinal parasite in the US

Answer 13

giardia lamblia - increased suspicion if travel hx, weight loss. is LEAST likely to cause bloody diarrhea

Question 14

is diarrhea expected in PUD? is bloody stool expected in PUD?

Answer 14

no. may see guaic positive (occult) blood in stool but less commonly see frank blood

Question 15

meckel’s diverticulum sx

Answer 15

often asymptomatic

Question 16

elevated platelet count is a non specific marker of …

Answer 16

inflammation

Question 17

low protein and albumin levels

Answer 17

may reflect malnutrition, hepatic disease with poor synthetic function, or losses from a protein-losing enteropathy.

Question 18

diagnostic gold standard for celiac’s disease

Answer 18

small bowel biopsy showing villous atrophy

Question 19

IgA antiendomysial antibodies

Answer 19

useful test for celiac disease

Question 20

Antigliadin antibodies,

Answer 20

less reliable in dx of celiacs but could be used if other celiac testing is negative but clinical suspicion still high esp in kids<2yo

Question 21

how to test for giardia

Answer 21

don’t do regular ova and parasites test - can do giardia specific Ag testing and many labs automatically run this first when stool O+P ordered

Question 22

bacterial gastroenteritis dx

Answer 22

stool culture

Question 23

dx of C diff

Answer 23

stool assay for c diff toxin, not culture

Question 24

2 groups prone to c diff

Answer 24

on / recently finished abx, or those w/ underlying colitis

Question 25

abd US is good in these 3 situations

Answer 25

localized pain, mass, or acute abd pain

Question 26

H pylori presentation and definitive dx

Answer 26

• gastritis, rather than focal findings

- aby for screening but endoscopy w/ bx/culture is more definitive

Question 27

retics, binding capacity and iron levels in iron def anemia

Answer 27

low retics, high binding, low iron

Question 28

normocytic anemia = 3 types

Answer 28

lead poisoning, chronic disease, bm failure

Question 29

UC pathophys

Answer 29

crypt abscesses, rectal–>spreads proximal, relatively continuously

Question 30

crohn’s pathophys

Answer 30

can involve any part of alimentary tract from mouth to anus, patchy or confluent, rectal sparing, can have transmural inflammation—–>fistulas

Question 31

dx of UC/crohns

Answer 31

upper endoscopy + colonoscopy. CT can help distinguish between the two but high radiation so consider MRI enterography instead.

Question 32

thoughts on using barium enema for dx UC or crohn’s

Answer 32

the contrast could delay colonscopy. can get toxic megacolon esp w/ UC. typically do this after a colonoscopy test.

Question 33

Crohn’s disease red flags

Answer 33

Pain that awakens the child at night
Pain that can be localized
Involuntary weight loss or growth deceleration
Extraintestinal symptoms (e.g., fever, rash, joint pain, aphthous ulcers, or dysuria)
Sleepiness after attacks of pain
Positive family history of inflammatory bowel disease (although only positive in about 30% of patients)
Abnormal labs such as guaiac-positive stool, anemia, high platelet count, high ESR, hypoalbuminemia
Abnormalities in bowel function (e.g., diarrhea, constipation, incontinence)
Vomiting
Dysuria