Which essential questions will you ask a pediatric patient or his or her caregiver when the presenting complaint is bloody diarrhea?
To manage a pediatric patient with bloody diarrhea, it is essential to determine the etiology of symptoms and their character. For this reason, the first question should be about the acuteness of bleeding and its chronicity as it will help to identify basic characteristics of the pathology (Wolfram, 2017). Second, a patient should be asked about the color and quantity of the blood in his/her stools. It is needed to determine the source of bleeding (Wolfram, 2017). The patient or his/her caregiver should describe antecedent symptoms and history of straining (Wolfram, 2017). It is critical to ask whether the patient has experienced some traumas or not. Finally, the caregiver should provide a detailed history of consumed food and say if the patient has used particular drugs (Wolfram, 2017). These questions are fundamental when managing bloody diarrhea.
Will these questions vary depending upon the child’s age?
The questions will not vary as for patients of all ages acute bloody diarrhea remains a medical emergency that demands immediate intervention. For this reason, it is critical to ask all these questions.
Why or why not?
Moreover, the age of the patient is an important factor that should be considered when diagnosing bloody diarrhea in pediatric patients. If this characteristic is appropriate, diagnosis of intussusception should be taken into account. Usually, these are infants not older than two years (Blanko, 2017). For this reason, the age of the patient becomes a critical factor that will determine the future treatment, diagnostic studies, and interventions.
What clinical or historical findings will indicate the need for diagnostic studies and why?
If the pediatric patient demonstrates uncomplicated diarrhea and his/her state improves within a few days, there is no need for the additional search for the cause of this gastrointestinal upset (Prescilla, 2016). However, if diarrhea is severe and protracts with blood and other symptoms, additional investigation and diagnostic studies might be needed to determine the etiology of the pathology and symptoms. Additionally, if the patient has been in foreign countries characterized by a poor epidemiologic environment, specific diagnostic studies might be needed to find pathogens causing presenting symptoms and bloody diarrhea and exclude extremely contagious diseases that pose a threat to the environment.
Which diagnostic studies will you initially order and why?
First, stool cultures should be analyzed to determine bacterial etiologies. It is fundamental for the further treatment of gastrointestinal upset. A complete blood count is also helpful when diagnosing patients with bloody diarrhea as it might show an increased level of hemoglobin indicating dehydration (Prescilla, 2016). For patients who might have E Coli O157:H7 infection the constant monitoring of platelet counts and hemoglobin levels is useful (Mathieson, 2015). Blood count could also help to indicate Salmonella through leukocytosis or relative pandemic (Mathieson, 2015). In general, these studies might help to create a complete image of the case and prescribe an appropriate treatment.
What would be three differential diagnoses in this case?
Regarding the peculiarities of the case, the three possible differential diagnoses might include viral gastroenteritis, bacterial gastroenteritis, and intussusception. These gastrointestinal upsets are characterized by common symptoms like diarrhea, vomiting, loss of fluids, abdominal pain, etc. (Krucik, 2017). For this reason, further investigation of the case to exclude differentials and determine the primary cause for the development of pathology.
How do the common causes of vomiting differ in infants, children, and adolescents?
In infants, forceful vomiting might indicate serious or emergency conditions including a blockage, narrowing of the stomach, or intestinal obstruction. Moreover, vomiting in newborns might be caused by infections of the intestine, or other parts (Di Lorenzo, 2017). As for children, the most typical cause triggering vomiting is infections gastroenteritis stipulated by a virus. The second reason is the poor quality of consumed food (Di Lorenzo, 2017). Finally, respiratory and urinary tract infections, hypertension, and other pathologies might trigger vomiting in children. Speaking of adults, the most common cause for this reaction is the same, and it is infectious gastroenteritis. However, reasons might include appendicitis, pregnancy, pancreatitis, substance overdose, bowel disease, etc. (Di Lorenzo, 2017). The diversity and different characteristics of the primary causes of vomiting evidence the complexity of its diagnosis.
What clinical or historical findings will indicate the need for diagnostic studies and why?
Regarding the suggested case, the following findings should be considered. First, the patient is 18 months old which means that she might suffer from intussusception. Second, the patient vomits 4-5 times per day. Third, she suffers from diarrhea 3 times per day. In such a way, she loses fluids and might suffer from dehydration. Finally, her sister had similar symptoms several days ago; however, the cause for the appearance of these symptoms in her remains unknown. These evidence the presence of a particular pathology that should be investigated to determine the etiology of these symptoms and prescribe an appropriate treatment.
Which diagnostic studies will you initially order and why?
A complete blood count for the further treatment of this gastrointestinal upset is needed. It might show an increased level of hemoglobin and dehydration. Stool cultures analysis might be helpful in investigating the case and determining bacterial etiologies. However, regarding the fact that the patient has a two-day history of diarrhea and vomiting, additional studies might be unnecessary. If the patient demonstrates uncomplicated diarrhea with no blood and her state improves (parents admit a slightly decreased amount of wet diapers per day), there is no need for the additional research (Guandalini, 2017). The patient tolerates liquids and could be nursed. For this reason, improvement of her state might be expected.
References
Blanko, F. (2017). Intussusception. Web.
Di Lorenzo, C. (2017). Patient education: Nausea and vomiting in infants and children. Web.
Guandalini, S. (2017). Diarrhea workup. Web.
Krucik, G. (2017). Viral gastroenteritis. Web.
Mathieson, L. (2015). Vomiting and diarrhoea in children. InnovAiT, 8(10), 592-598. Web.
Prescilla, R. (2016). Pediatric gastroenteritis workup. Web.
Wolfram, W. (2017). Pediatric gastrointestinal bleeding clinical presentation. Web.