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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?
Acute diarrhea infections are a usual health concern in the world including people within the United States visiting third world countries. Multiple methodologies on therapies including antibiotic as well as non-antibiotic have been applied to offer treatment to the usual ailments. The knowledge on prevention, diagnostic and treatment and the implication of acute diarrhea has come into view and has assisted in the process of clinical management (Cash & Glass, 2014).
The most crucial question to ask the caregiver is whether the stool appears black and tar-like. The presence of blood in diarrhea means that there is gastrointestinal bleeding. The stool appearing like tar is a result of bleeding the upper part of the digestive tract. It is important to realize that the agents causing diarrhea in children and infants differ depending their age (Burns, C., et al, 2013). The causes of bloody diarrhea for children of the age of one year or less are mostly intestinal infection such as infant colitis. For the children above the age of one year, the common causes of intestinal infection include ulcerative colitis and Crohn’s colitis. Examples of questions are:
–Any change in appetite?
– Did you note weight gain or loss?
-Do you observe any intolerance to certain foods?
-Any nausea and/or vomiting episode observed?
-Did the patient presents change in bowel habits?
-Did the patient presents any blood in the bowel movement?
– Describe color and quantity
-Any abdominal pain?
-Describe location and if it radiates
-Describe pain intensity in a scale 1-10
-Describe frequency, quality
Cases of blood in diarrhea should be treated immediately though most of the cases observed are not serious. However, patients who notice blood in their stool should seek medical attention. In this case, tests carried out depend on the age of the patients. The factors that the doctor should consider are the individual situation and symptoms exhibited. The most commonly applied tests to assess the reason behind the blood stools include a rectal exam, anoscopy, colonoscopy otherwise known as sigmoidoscopy. The initial diagnostic that the doctor may take is the rectal exam. In this exam, the doctor will use the finger to assess the internal parts of the anus and observe the external parts as well.
What would be three differential diagnoses in this case?
In the I Human case study of Samantha Graves, the differential diagnosis were:
-Viral gastroenteritis
-Parasitic Gastroenteritis
-Appendicitis
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?
Vomiting is a symptom that has frequently been reported in children. A critical assessment has to be carried out to determine the causes which may call for immediate medical attention. Several elements have to be considered including the onset, duration, and frequency of the vomit. At any age of human development, bilious vomiting has to be addressed urgently seriously and obtaining the past medical status of any persistent bouts of vomiting is crucial (InKoch & In Hasler, 2017). Children and young people with gastroenteritis have been realized to get better with the introduction of ondansetron. In the same line, ondansetron has also been discovered to reduce the population children as well as the young people in necessity of intravenous fluid therapy and step down the patients’ hospital visits by a significant margin. The National Institute for Health and Care Excellence developed a clinical guideline for vomiting and diarrhea as a result of gastroenteritis. The identification of the illness, examination, and management for the children under the age of five years concluded that prescription of antiemetic could not be recommended as at now. Nevertheless, more studies on the application of ondansetron were required, mostly looking at the probable risk of increasing diarrhea (National Institute for Health and Care Excellence, 2014).
In summary, we can rightly conclude that patients with diarrhea and vomiting should seek medical attention urgently. It should be noted that diarrhea is one of the most reported illnesses in the world. In fact, it is the primary cause of mortality for children under the age of four years. On the other hand, cases of vomiting should also be taken seriously so that it may be diagnosed early.
References
Burns, C., Dunn, Brady, Starr, N. B., Blosser. (2013). Pediatric primary care. (5th ed.). Retrieved from https://digitalbookshelf.southuniversity.edu/#/boo…
Cash, J. C. & Glass, Ch. A. (2014). Family practice guidelines, (3rd ed.). Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780826168757/
In Koch, K. L., & In Hasler, W. L. (2017). Nausea and vomiting: diagnosis and treatment.
National Institute for Health and Care Excellence. (2014). Management of vomiting in children and young people with gastroenteritis: ondansetron.
Expert Solution Preview
When a pediatric patient presents with bloody diarrhea, it is essential to ask the caregiver if the stool appears black or tar-like, as this indicates gastrointestinal bleeding. The questions asked may vary depending on the child’s age, as the cause of bloody diarrhea differs among age groups. For infants under one year, the most common cause is intestinal infections such as infant colitis, while children over one year may have ulcerative colitis or Crohn’s colitis. Other questions regarding appetite changes, weight changes, food intolerance, nausea or vomiting episodes, bowel habit changes, and abdominal pain should also be asked. Diagnostic tests, such as rectal exams, anoscopy, and colonoscopy, may be necessary depending on the individual’s age, situation, and symptoms.
In the case study provided, the three differential diagnoses for Samantha Graves’ condition were viral gastroenteritis, parasitic gastroenteritis, and appendicitis.
The common causes of vomiting differ in infants, children, and adolescents. It is crucial to consider the onset, duration, and frequency of vomiting when assessing the cause, as well as obtaining a medical history of any persistent bouts. Bilious vomiting is an urgent concern at any age, and antiemetic medication may be prescribed, such as ondansetron, to reduce hospital visits and intravenous fluid therapy. However, more research must be conducted on the potential risk of increasing diarrhea with ondansetron use. Urgent medical attention is necessary for patients presenting with diarrhea and vomiting, as diarrhea is the primary cause of mortality for children under four years old, and vomiting may signify a severe underlying condition.
