CLIPP 27 Flashcards
most common cause of abd pain in school-age kids
functional - is chronic, recurrent, usually nonspecific and not life threatening; kids w/ this often have somatic complaints
categorization of functional abd pain
functional dyspepsia, abdominal migraine, irritable bowel syndrome, functional abdominal pain syndrome
diagnosis of functional abd pain
no alarming signs or sx, normal physical exam, stool negative for occult blood
treatment of abd pain
reassurance, possibly psychological referral
concerning signs/sx in pediatric abd pain that warrant more workup
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
slowing of weight gain, or weight loss
can be first sign that is indicative of chronic disease
drop in height velocity
suggest long standing illness
heel tap tenderness
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
rectal exams in pediatrics aids in the dx of
GI bleed, intussusception, rectal abscess, impaction
stool guaiac test
confirms presence of blood in stool
classic celiac dz presentation
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.
common bugs in GI bacterial infection
yersina, salmonella, shigella, campy - TYPIVALLY will present as acute process
most common intestinal parasite in the US
giardia lamblia - increased suspicion if travel hx, weight loss. is LEAST likely to cause bloody diarrhea
is diarrhea expected in PUD? is bloody stool expected in PUD?
no. may see guaic positive (occult) blood in stool but less commonly see frank blood
meckel’s diverticulum sx
often asymptomatic
elevated platelet count is a non specific marker of …
inflammation
low protein and albumin levels
may reflect malnutrition, hepatic disease with poor synthetic function, or losses from a protein-losing enteropathy.
diagnostic gold standard for celiac’s disease
small bowel biopsy showing villous atrophy
IgA antiendomysial antibodies
useful test for celiac disease
Antigliadin antibodies,
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
how to test for giardia
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
bacterial gastroenteritis dx
stool culture
dx of C diff
stool assay for c diff toxin, not culture
2 groups prone to c diff
on / recently finished abx, or those w/ underlying colitis
abd US is good in these 3 situations
localized pain, mass, or acute abd pain
H pylori presentation and definitive dx
- gastritis, rather than focal findings
- aby for screening but endoscopy w/ bx/culture is more definitive
retics, binding capacity and iron levels in iron def anemia
low retics, high binding, low iron
normocytic anemia = 3 types
lead poisoning, chronic disease, bm failure
UC pathophys
crypt abscesses, rectal–>spreads proximal, relatively continuously
crohn’s pathophys
can involve any part of alimentary tract from mouth to anus, patchy or confluent, rectal sparing, can have transmural inflammation—–>fistulas
dx of UC/crohns
upper endoscopy + colonoscopy. CT can help distinguish between the two but high radiation so consider MRI enterography instead.
thoughts on using barium enema for dx UC or crohn’s
the contrast could delay colonscopy. can get toxic megacolon esp w/ UC. typically do this after a colonoscopy test.
Crohn’s disease red flags
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
