Which essential questions will you ask a pediatric patient or his or her caregiver when the presenting complaint is bloody diarrhea? Will these questions vary depending upon the child’s age? Why or why not? What clinical or historical findings will indicate the need for diagnostic studies, and why? Which diagnostic studies will you initially order, and why?
Wolfram (2017) states that the questions to ask a pediatric patient or his or her caregiver in relation to bloody diarrhea have to be age and etiology-specific. The questions will include:
- What is the age of the child?
- Is the bleeding chronic or acute?
- How much blood is present in the stool, and what color is it?
- Is there abdominal pain or straining before or during defecation?
- Is the child taking any supplements that can change the color of the stool?
- Are there any other GI symptoms (vomiting, pain, etc.)?
- Is there a history of NSAID use?
- Has the child eaten any red-colored foods in the past few days?
- Is the child’s body temperature normal?
- If the child is less than four years old, is he or she breastfed?
- Were there any incidents of bloody stool or diarrhea in the past?
These questions will also vary depending on the child’s age. For instance, if the child is less than two years old and is breastfed, blood in the stool and diarrhea may be due to the mother’s use of medications or the swallowing of the mother’s blood during breastfeeding (Wolfram, 2017). If there is no evidence that the child consumed the foods that could change the color of the stool, acute bloody diarrhea should be treated as an emergency (Wolfram, 2017). Additional diagnostic tests would include blood tests and a stool analysis, which could determine the presence of intestinal infection (Holtz, Neill, & Tarr, 2009).
What would be three differential diagnoses in this case?
The three differential diagnoses, in this case, would be gastroenteritis (Dalby-Payne & Elliott, 2011), intestinal infection (Holtz et al., 2009), and inflammatory bowel disease (Burns, Dunn, Brady, Starr, & Blosser, 2013). All of these diagnoses can cause bloody diarrhea, abdominal pain, vomiting, and other related symptoms. In order to differentiate between the diagnoses, it is essential to conduct further examinations. For instance, the lack of pathological bacteria in the stool would rule out the intestinal infection (Holtz et al., 2009). The absence of other GI infection symptoms, such as vomiting, abdominal pain, or fever, would generally point towards the inflammatory bowel disease, although there are cases where gastroenteritis is not associated with symptoms other than diarrhea (Dalby-Payne & Eliott, 2011).
How do the common causes of vomiting differ in infants, children, and adolescents? What clinical or historical findings will indicate the need for diagnostic studies, and why? Which diagnostic studies will you initially order, and why?
According to Wang (2011), common causes of vomiting differ a lot between infants and children or adolescents, but there are no significant differences between adults and adolescents. In infants, acute vomiting can be caused by gastroenteritis, pyloric stenosis, sepsis and non-GI infections, and metabolic disorders, as well as by Hirschsprung’s disease (Wang, 2011). Chronic vomiting, on the other hand, occurs due to gastroesophageal reflux disease, food intolerances, congenital atresias and stenosis, malrotation, and intussusception (Wang, 2011).
In children and adolescents, the list of causes expands to include toxic ingestion, appendicitis, and pregnancy, whereas chronic vomiting may also be caused by gastritis, eating disorders, and intracranial hypertension (Wang, 2011). In the case of infectious diseases or food poisonings, vomiting will usually cease when the cause has cleared, and no diagnostics or treatment is required. However, in the case of acute abdominal pain or persistent vomiting, additional tests are required. For instance, urine, stool, and blood tests can be used to identify the infection and find a suitable treatment. EGD, on the other hand, will help to rule out ulcers, whereas an ultrasound will help to identify appendicitis and pyloric stenosis (Wang, 2011).
References
Burns, C., Dunn, A., Brady, M., Starr, N. B., & Blosser, C. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier Saunders.
Dalby-Payne, J. R., & Elliott, E. J. (2011). Gastroenteritis in children. Clinical Evidence, 7(1), 314-377.
Holtz, L. R., Neill, M. A., & Tarr, P. I. (2009). Acute bloody diarrhea: A medical emergency for patients of all ages. Gastroenterology, 136(6), 1887-1898.
Wang, B. W. (2011). Approach to vomiting. Learn Pediatrics. Web.
Wolfram, W. (2017). Pediatric gastrointestinal bleeding. Medscape. Web.