MedU Clipp 27

Question 1

Abdominal Symptoms that Require Further Evaluation?

Answer 1

• Involuntary Weight Loss
• Deeleration of Linear Growth
• Gastrointestinal blood loss
• Significant Vomiting
• Chronic Severe Diarrhea
• Persistant Right Upper or Right Lower Quadrant Pain
• Unexplained Fever
• Family Hx of Inflammaroty Bowel Disease
• Abdominal or Unexplained Physical Findings

Question 2

What can a Rectal exam help Diagnose?

Answer 2

• Gastrointestinal Bleeding
• Intussusception
• Rectal Abscess
• Impaction

Question 3

What is the Major cause of Microcytic Anemia in Children?

Answer 3

Iron Deficiency –> Decreased RBC production

Question 4

What are some Red Flags of Crohn’s Disease?

Answer 4

• Pain that awakens the child at night
• Localized Pain
• Involuntary weight loss or Growth deceleartion
• Extraintestinal (Fever, Rash, Joint Pain, Aphthous Ulcers)
• Sleepiness after attacks of Pain
• FHx of IBD
• Guaiac-positive stool, Anemia, High Platelet Count, High ESR, Hypoalbuminemia
• Abnormalities in Bowel Function (diarrhea, constipation, incontinence)
• Vomiting and Diarrhea

Question 5

DDx Abdominal Pain and Bloody Stools?

Answer 5

• Inflammatory Bowel Disease
• Celiac Disease
• Bacterial Gastroenteritis
  
  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter
  • Clostridium Difficile
• Giardiasis (Giardia lamblia)
• PUD
• Henoch-Schonlein Purpura

Question 6

Laboratory Evaluation of Abdominal Pain and Bloody Stools?

Answer 6

• CBC w/ Differential
• Erythrocyte Sedimintation Rate (ESR)
• C-reactive Protein (CRP)
• Hepatic Profile (Protein and Albumin)
• IgA Tissue Transglutaminase Antibodies (TTG)
  
  • Celiac (IgA antiendomysial Ab)
• Stool Ova and Parasites (O&P) (Giardia-specific antigen)
• Stool Culture

Question 7

What defines Ulcerative Colitis?

Answer 7

• Relatively generalized inflammation is confined to teh mucosa, starting in the Rectum and Involving a variable extent of Colon proximally
• Crypt Abscesses are common
• Discontinuous inflammation at Dx or even Relative Rectal Sparing
• Inflammation becomes more confluent

Question 8

What defines Crohn’s Disease?

Answer 8

• Involves any portion of teh Alimentary tract, from Mouth to Anus
• Mucosal Inflammation may become more generalized or remain patchy and may extend gradually into the submucosa, muscularis, and serosa
• Transmural inflammation can result in fistula formation

Question 9

Treatment of Crohn’s Disease?

Answer 9

• Immunomodulators (standard of care)
• Mild Disease
  
  • Aminosalicylate like Mesalamine is 1st-line Rx for Tx
• Severe Disease
  
  • Coritocosteroids –> induce remission NF-kB
    
    • Prenisone
    • Prednisolone
    • Budesonide
    • Enteral nutrition w/ Methotrexate
    • Antitumor Necrosis factors (Infliximab and Adalimumamb for Maintenance therapy)