Docstoc

Ped Abdl Pain Case Summaries

Document Sample
Ped Abdl Pain Case Summaries Powered By Docstoc
					Pediatric Abdominal Pain Case Summary
Case 1

  8 year-old boy
  Episodes of abdominal pain for several months
  Occur anytime, often during supper
  Occasional nausea, no vomiting
  2 episodes of "embarrassing diarrhea" at school
  No weight loss, fever, systemic symptoms
  PMH, family Hx negative
  Good student, "busy" with sports, etc.


  Further Hx:
    No red flags
    Tends to be constipated, with "no time to go"


  Examination:
     Healthy looking; normal VS, HEENT, chest
     Abdomen normal, but mild LLQ tenderness, ?fullness
     Rectal normal, with large firm stool


  Lab and imaging:
Pediatric Abdominal Pain Case Summary
Case 2

  12 year-old girl
  Episodes of abdominal pain for four months
  Similar pains one year ago
  Pain comes at different times, often in morning
  Poor appetite, some nausea
  2 pound weight loss
  No fever or other systemic Sx; not yet menstruating
  PMH negative; father had an ulcer 3 years ago
  Does well in school, has good friends


  Further Hx:
     Feels a little better with antacids, food, and Pepcid AC
     Red flags: weight loss, sometimes awakens from sleep
         No melena


  Examination:
     Looks mildly ill; weight down slightly
     Normal VS, HEENT, chest
     Abdomen normal except for epigastric tenderness
     Rectal normal; brown stool, guaiac negative


  Laboratory:
     CBC, LFT, stool O/P, ESR normal
Pediatric Abdominal Pain Case Summary
Case 3

  13 year-old girl
  4-6 months of episodic, crampy mid-abdominal pain
  Often after meals and after soccer
  Poor appetite; some nausea; vomited twice
  "Feverish;" 4 pound weight loss
  PMH, Family Hx negative
  School stressful


  Further History:
     Some arthralgias; diarrhea a few times
     No unusual rash, rectal bleeding, mouth sores


  Examination:
     Lean, mildly ill-appearing. Temp 99.5; other VS normal
     Abdomen mildly tender near umbilicus and RLQ; no mass
     Rectal normal


  Laboratory:
     Hct 32; WBC, plts normal. ESR 36
     LFT, amylase, stool O/P, UA normal


  Imaging:
     UGI with SBFT: disease in terminal ileum
Pediatric Abdominal Pain Case Summary
Case 4

  10 year-old girl
  24 hrs not feeling well, periumbilical aching pain
  No appetite; nauseated; had small bowel movement yesterday
  Seemed "feverish" at home; no weight loss or other systemic Sx
  Overweight but otherwise negative PMH; negative family Hx
  Stress from adjustment to recent move


  Further History:
     No unusual foods or travel
     Had a URI last week but nearly gone


  Examination:
     Looks overweight and mildly ill
     Temp 99.8, VS otherwise normal
     HEENT, lungs normal
     Abdomen tender near umbilicus and in RLQ; rectal normal
     Hurts when pelvis is shaken


  Laboratory:
     Hct 38, WBC 10,900, 70% neutrophils
     ESR 12; UA normal


  Imaging:
Pediatric Abdominal Pain Case Summary
Case 5

  7 year-old boy, previously healthy
  3 months of episodes of crampy mid-abdominal pain
  Almost daily; duration variable; improved with rest
  Normal appetite, no nausea or vomiting
  No fever, weight loss, other systemic symptoms
  Family Hx: colon cancer, PUD
  Doing well in school; has friends; family intact


  Further History:
     No red flags


  Examination:
     Healthy-looking, normal VS
     HEENT, chest, abdomen, rectal all normal
     Normal development and mental status


  Laboratory:
     CBC, ESR, UA, stool guaiac and O/P all normal


  Imaging: