Question

GI: Patrick O’Donnell

SubjectivePatrick O’Donnell is a 22-month-old boy of Irish-American descent. His mother has concerns about loose stools for the past 3-4 months. His stools have gradually become looser and more frequent, and he has been “irritable” lately. His mother says he is active and sleeps well. She describes him as a “picky eater.”Patrick lives with both parents and a 4-year-old sister, who is healthy.Because both parents work full-time, Patrick and his sister go to their grandmother’s home Monday through Friday form daycare.His mom had not been particularly concerned about his crabbiness or picky eating until his Grandma mentioned that Patrick has been taking longer naps and she wonders how he'll ever get potty trained because of his loose stools. Objective : Vital signs include:weight (10.8 kg/23 lb13 oz), length (84 cm/33.25”), and temperature (97.6 F).Some of Patrick's physical exam findings are as follows:General:Patrick is a thin, somewhat pale toddler, sitting quietly on his mother’s lap.Cardiac:Cardiac exam is normal (no murmurs,cyanosis, or clubbing).GI:His GI exam reveals a slightly distended abdomen, active bowel sounds, some tympany,non-tender to palpation, without masses or hepatosplenomegaly.Skin:His skin is pale, with no rashes or lesions.You order some lab work:CBC:All WNL for age except Hgb is 10.0 g/dL: (ref: 11.0 to 14.0 g/dL) tTG (TissueTransglutaminase):14.6 u/ml (ref:<4.0 is negative, 4 to 10 is weak positive, and >10.0 is positive)Assessment and Plan:Putting it all together: 1.Identify and discuss/analyze the most important aspects of Patrick's listed history ("red flags" in the subjective findings). What items are missing from Patrick's history? 2.Identify and discuss/analyze the most important objective findings. What data is missing from a complete exam for this patient? 3.State your assessment:List differential diagnoses for this patient (pretend you don't know the given lab results).4.Clearly state both a short-term and long-term plan for Patrick.Include diagnostic testing, consults, referrals, patient education, follow-up. Discuss the rationale for the measures contained in your plan, using peer reviewed, evidence based, primary academic references to support your rationale.

Answer 1

Ans

As heamogolbin is less in the laboratory examination and also the skin is pale and abdomen is distended

It reflect toward the anemia in the child

As history says that there is loose stool that lead to inhibition of absorption

Mission history and laboratory investigations

1. Examination of stool for any parasite infection

2. Investigation of peripheral blood smear

3. Fluid thrill and nature of fluid that cause distension ofthe abdomen

Management

Give medication like loperamide for control of loose motion

Give vitamin and iron supplements

If abdomen distension is more then aspirate the fluid

Take proper care of diet of child

Give proper diet to the child abd more of the nutrition as it loss by loose motion