Chapter 40 - GI Disorders - ANSWER
The parent of a colicky infant asks about using a probiotic medication.
What will you tell them? - ANSWER There is no conclusive evidence about using probiotics to treat colic.
A toddler who was born prematurely refuses most solid foods and has poor wei...
The parent of a colicky infant asks about using a probiotic medication.
What will you tell them? - ANSWER There is no conclusive evidence about using probiotics to treat colic.
A toddler who was born prematurely refuses most solid foods and has poor weight gain. A barium
swallow study reveals a normal esophagus.
What will the primary care pediatric nurse practitioner consider next to manage this child's nutritional
needs? - ANSWER Video fluoroscopy swallowing study
A toddler is seen in the clinic after a 2 day history of intermittent vomiting and diarrhea. An assessment
reveals an irritable child with dry mucous membranes, 3 second capillary refill, 2 second recoil of skin,
mild tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past
24 hours.
What will the primary care pediatric nurse practitioner recommend? - ANSWER Oral rehydration solution
with follow-up in 24 hours.
A 9-year-old girl has a history of frequent vomiting, and her mother has frequent migraine headaches.
The child has recently begun having more frequent and prolonged episodes accompanied by headaches.
An exam reveals abnormal eye movements and mild ataxia.
What is the correct action? - ANSWER Refer to a pediatric gastroenterologist for further workup.
The parent of a 3-month-old reports that the infant arches and gags while feeding and spits up
undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12 th
percentile.
, What is the best course of treatment for this infant? - ANSWER Begin a trial of extensively hydrolyzed
protein formula for 2-4 weeks.
A school age child has a 3-month history of dull, aching epigastric pain that worsens with eating and
awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL.
What is the next step in management? - ANSWER Refer for EGD.
A 2-month-old infant cries up to 4 hours each day and, according to the parents, is inconsolable during
crying episodes with fists and legs noted to be tense and stiff. The infant is breastfeeding frequently but
is often fussy during feedings. The physical exam is normal, and the infant is gaining weight normally.
What will the primary care pediatric nurse practitioner recommend? - ANSWER Eliminating certain foods
from the mother's diet.
A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a 6 mm
cylindrical object in the child's stomach. The child is able to swallow without difficulty and is not
experiencing pain.
What is the correct course of treatment? - ANSWER Have the parents watch for the object in the child's
stool.
A 10-year-old child has had abdominal pain for 2 days, which began in the
periumbilical area and then localized to the right lower quadrant. The child vomited once today and then
experienced relief from pain followed by an increased fever.
What is the likely diagnosis? - ANSWER Appendicitis with perforation
An 18-month-old child has a 1 day history of intermittent, cramping abdominal pain with nonbilious
vomiting. The child is observed to scream and draw up his legs during pain episodes and becomes
lethargic in between. The primary care pediatric nurse practitioner notes a small amount of bloody,
mucous stool in the diaper.
, What is the most likely diagnosis? - ANSWER Intussusception
A school age child has had abdominal pain for 3 months that occurs once or twice weekly and is
associated with a headache and occasional difficulty sleeping, often causing the child to stay home from
school. The child does not have vomiting or diarrhea and is gaining weight normally. The physical exam is
normal.
According to Bishop, what is included in the initial diagnostic workup for this child? - ANSWER CBC
ESR
Amylase
Lipase
UA
Abdominal ultrasound
An adolescent is diagnosed with functional abdominal pain (FAP). The child's symptoms worsen during
stressful events, especially with school anxiety.
What will be an important part of treatment for this child? - ANSWER Teaching about the brain gut
interaction causing symptoms.
A school age child has recurrent diarrhea with foul smelling stools, excessive
flatus, abdominal distension, and failure to thrive. A 2-week lactose free trial failed to reduce symptoms.
What is the next step in diagnosing this condition? - ANSWER Serologic testing for celiac disease.
A child is diagnosed with Crohn's disease.
What are likely complications? - ANSWER Intestinal obstruction with scarring and strictures.
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