Differential & Work-up: Pedia-GI symptoms, Short Stature

Question 1

1 mo infant is brought in because she has been spitting up her milk for the past 10 days. The vomiting episodes have increased in frequency and forcefulness. Emesis is non-bloody and nonbilious. The episodes usually occur immediately after breastfeeding. She has stopped gaining weight.

Answer 1

1. Pyloric stenosis
2. Partial duodenal atresia
3. GERD
4. Gastroenteritis
5. Hepatitis
6. UTI

Question 2

WORK-UP FOR:

1. Pyloric stenosis
2. Partial duodenal atresia
3. GERD
4. Gastroenteritis
5. Hepatitis
6. UTI

Answer 2

1. CBC
2. Electrolytes
3. U/S-abdomen
4. Barium swallow
5. Esophageal pH probe
6. Endoscopy
7. LFTs, alkaline phosphatase
8. UA, urine culture

Question 3

3 yo M presents with constipation. The child has had 1 bowel movement per week since birth despite the use of stool softeners. At birth, he did not pass meconium for 48 hours. He has poor weight gain. There is a family history of this problem.

Answer 3

1. Hirschsprung disease
2. Low-fiber diet
3. Anal stenosis
4. Hypothyroidism
5. Lead poisoning
6. Celiac disease

Question 4

WORK UP FOR:

1. Hirschsprung disease
2. Low-fiber diet
3. Anal stenosis
4. Hypothyroidism
5. Lead poisoning
6. Celiac disease

Answer 4

1. Rectal exam
2. Barium enema
3. Suction rectal biopsy
4. Anorectal manometry
5. TSH, FT4
6. CBC
7. Electrolytes
8. Serum lead level
9. Anti-tissue transglutaminase, anti-endomysial & total IgA antibodies

Question 5

8 mo F presents with sudden onset colicky abdominal pain with vomiting. The episodes are 20 minutes apart, and the child is completely well between episodes. She had loose stools several hours before the pain, but her stools are now bloody.

Answer 5

1. Intussusception
2. Appendicitis
3. Meckel diverticulum
4. Volvulus
5. Gastroenteritis
6. Enterocolitis
7. Blunt abdominal trauma

Question 6

WORK UP FOR:

1. Intussusception
2. Appendicitis
3. Meckel diverticulum
4. Volvulus
5. Gastroenteritis
6. Enterocolitis
7. Blunt abdominal trauma

Answer 6

1. Rectal exam, stool for occult blood
2. CBC
3. Electrolytes
4. Contrast enema
5. U/S-abdomen
6. CT-abdomen

Question 7

7 yo M presents with abdominal pain that is generalized, crampy, worse in the morning, and seemingly less prominent during weekends and holidays. He has missed many school days because of the pain. Growth and development are normal. His parents recently divorced.

Answer 7

1. Somatoform disorder
2. Malingering
3. Irritable bowel syndrome
4. Lactose intolerance
5. Child abuse

Question 8

WORK UP FOR:

1. Somatoform disorder
2. Malingering
3. Irritable bowel syndrome
4. Lactose intolerance
5. Child abuse

Answer 8

1. CBC
2. Electrolytes
3. U/S-abdomen
4. Amylase, lipase
5. Stool exam

Question 9

2 mo M presents with persistent crying for 2 weeks. The episodes subside after passing flatus or eructation. There is no change in appetite, weight, or growth. There is no vomiting, constipation, or fever.

Answer 9

1. Colic
2. Formula allergy
3. GERD
4. Lactose intolerance
5. Strangulated hernia
6. Testicular torsion
7. Gastroenteritis

Question 10

WORK UP FOR:

1. Colic
2. Formula allergy
3. GERD
4. Lactose intolerance
5. Strangulated hernia
6. Testicular torsion
7. Gastroenteritis

Answer 10

1. Rectal exam, stool for occult blood
2. U/S-abdomen
3. U/S-testicular

Question 11

14 yo M presents with short stature and lack of sexual development. His birth weight and length were normal, but he is the shortest child in his class. His father and uncles had the same problem when they were young, but they are now of normal stature.

Answer 11

1. Constitutional short stature
2. Growth hormone (GH) deficiency
3. Hypothyroidism
4. Chronic renal insufficiency
5. Genetic causes

Question 12

WORK UP FOR:

1. Constitutional short stature
2. Growth hormone (GH) deficiency
3. Hypothyroidism
4. Chronic renal insufficiency
5. Genetic causes

Answer 12

1. CBC with differentials
2. Electrolytes
3. GH stimulation test
4. IGF-l, IGFBP-3 levels
5. TSH, FT4
6. XR-hand
7. U/S-renal and cardiac
8. BUN/Cr