Peds 27 Flashcards
Of the following, which is the most common cause of abdominal pain in school-aged children?
Functional abdominal pain
Jenny is an 8-year-old female with worsening chronic, intermittent, crampy abdominal pain associated with poor growth, weight loss, diarrhea and bloody stools, but without vomiting or fevers.
What’s the most likely dx?
Inflammatory bowel disease
Which of the following studies would be most helpful in confirming the diagnosis of inflammatory bowel disease (IBD)? Why?
Upper endoscopy & Colonoscopy
To obtain tissue biopsy to help distinguish between Crohn’s disease and ulcerative colitis
What’s the management plan for Crohn’s disease?
Induction therapy to put disease in remission
- Corticosteroids trial to induce remission
- enteral nutrition therapy - may require NG or Gtube
Maintenance therapy
- immunomodulators (thiopurines, methotrexate)
- anti-TNF therapy for moderate to severe CD
- surgery is an option (more likely in UC), but consider if CD is refractory to medical therapy
A 2-year-old female is brought to the ED by her mother because of increasingly frequent abdominal pain. She has been experiencing this pain on and off for the past year, along with increasing abdominal distention, vomiting, and diarrhea. You chart her height and weight, and find that she is below the 5th percentile for both. IgA tissue transglutaminase (TTG) antibody returns positive. What is the best treatment for this child?
A. Antibiotic treatment B. Corticosteroids C. Gluten-free diet D. Metronidazole E. Pain management
C. Gluten-free diet
A gluten-free diet is the best way to manage celiac disease. Celiac disease can present with chronic abdominal pain, vomiting, abdominal distention, and diarrhea. Growth failure can result from malabsorption or anorexia. Anemia may also result from occult GI bleeding, although frank blood in the stool is rare. The IgA tissue transglutaminase antibody titer is a very sensitive and specific test for this disease.
An 11-year-old male comes to the clinic with a chief complaint of abdominal pain for three months. The pain is not associated with eating. Sometimes he feels full and nauseated along with the pain, but then it resolves on its own. He denies diarrhea, vomiting, and bloody stools. He started a new school four months ago. His mother is primarily concerned because his abdominal pain causes him to miss school quite often now. He is otherwise healthy. When you evaluate his growth curves, he is progressing at the 60th percentile for height and weight and you do not notice a change since birth. He is an honors student. Vital signs are normal. Physical exam, including genital and rectal is normal. Stool is negative for occult blood. What is the most likely diagnosis in this child?
A. Bacterial gastroenteritis B. Functional abdominal pain C. Inflammatory bowel disease D. Meckel's diverticulum E. Peptic ulcer disease
B. Functional abdominal pain
An 8-year-old girl is brought to clinic because of intermittent, crampy abdominal pain that has persisted over the last three months. The pain is nonspecific, nonfocal, and not associated with any other systemic symptoms such as fever, chills, weight loss, nausea, vomiting or diarrhea. The pain also seems to occur more frequently during the week and not as often on weekends. The abdominal exam is normal. The patient is given a diagnosis of functional abdominal pain. Six months later, she returns to the clinic complaining of more frequent, more severe abdominal pain that is waking her up at night. She also reports a week of diarrhea containing mucus and blood without associated fever or vomiting. Review of her growth chart demonstrates a slowing of weight gain and a drop in height velocity. What is the most likely diagnosis?
A. Celiac disease B. Crohn's disease C. Giardiasis D. Henoch-Schonlein purpura (HSP) E. Irritable bowel syndrome
B. Crohn’s disease
A 12-year-old boy comes to your clinic with a chief complaint of crampy abdominal pain. His mother tells you that sometimes he wakes up from sleep due to the pain. He also has diarrhea that sometimes has blood in it. When asked about stressors in his life, his mother sighs and tells you that she is recently divorced. On physical exam, he appears small for his age. Abdomen is soft, non-distended, but tender to palpation at the RUQ. On rectal exam, you note anal skin tags and an anal fistula. Skin exam shows red tender nodules on his shins. What is the next best step in management?
A. Colonoscopy B. Obtain IgA anti-tissue transglutaminase antibody C. Reassure and refer to psychiatry D. Start omeprazole and antibiotics E. Start mesalamine
A. Colonoscopy
What’s the difference in the areas of inflammation in Crohn’s disease vs ulcerative colitis?
Crohn’s - inflammation can involve any portion of alimentary tract, from mouth to anus
UC - inflammation confined to mucosa, starting from rectum and involving variable extent of colon proximally
What might be some distinguishing finding in Crohn’s vs UC?
Crohn’s - fistula, skin tags (on endoscopy or rectal exam)
UC - crypt abscesses (on microscopic pathology)
