Discussion: diagnosis and management of gastrointestinal disorders

Gastrointestinal disorders are a significant cause of stress for pediatric patients and their families. Symptoms of these disorders range from mild to severe and may include complaints such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can result in these same symptoms, it is important to carefully assess patients to develop differential diagnoses. Depending on the age of the patient, assessments can sometimes be difficult because younger children are not always able to clearly communicate their symptoms. Pediatric patient Assessments must involve a combination of patient input, parent input, and your own observations from physical exams and diagnostics. As you read the following three case studies, consider the source (i.e., patient, parent, or practitioner) of the provided patient information.

Case Study 1

Jordan is a 4-year-old with a 1-day history of vomiting and diarrhea. His mother reports he awoke this morning vomiting and his vomitus contained last night’s dinner. He vomited three more times this morning but has not vomited in 5 hours. Approximately one hour ago, he had a large diarrhea stool that did not contain blood or mucus. He has had small sips of sports drinks since this morning. His last urination occurred 3 hours ago and the volume was small and the color dark yellow. Physical examination reveals a quiet and tired child with normal exam except for increased bowel sounds, but no abdominal distension, pain with palpation, or masses.

Case Study 2

Victoria is a 15-year-old who complains of chronic sore throat and bad taste in her mouth. Her height and weight are appropriate for age and she remains on the same growth trajectory since infancy. Abdominal examination and chest examination are negative. History reveals frequent burping and occasional feelings of regurgitating food. Diet history reveals she eats a balanced diet, but her primary sources of fluids are coffee, tea, and carbonated drinks.

Case Study 3

Trish is a 7-year-old who presents with abdominal pain. Further questioning reveals frequent stool soiling and a history of chronic constipation since infancy. The child does not remember when her last bowel movement was, but her mother reports that she had an ”accident” at a family gathering last night where she defecated in her underwear prior to reaching the bathroom. Physical examination is benign except for the presence of palpable stool in the descending colon and an enlarged rectal vault with hard stool.

To prepare:

• Review “Gastrointestinal Disorders” of the Burns et al. text.
• Review and select one of the three provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
• Consider strategies for educating patients and families on the treatment and management of the gastrointestinal disorder

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the gastrointestinal disorder.