Paediatric-History taking & Physical examination of chronic diarrhea

Paediatric-History taking & Physical examination of chronic diarrheaCreated OnApril 23, 2020Last Updated OnApril 23, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of chronic diarrhea < All Topics Table of Contents History taking: A good history is important to get the clinical picture of patient’s problem. Ask about the chief complaint and history of presenting illness Onset Congenital: Chloridorrhea, Sodium malabsorption Abrupt: Infections Gradual: Everything else With introduction of wheat cereals: Coeliac disease Duration Quality of the stools Blood: Cow’s milk protein allergy, inflammatory bowel disease White/light, tan colour: Absence of bile, Coeliac disease Foul smelling or contain oil droplets: malabsorption Timing during the day and night, Day time only: Functional diarrhoea (chronic non-specific diarrhoea of childhood) Nocturnal: Organic etiology Aggravating and alleviating factors, and Any associated symptoms Presence of fever Presence of vomiting Current urine output Abdominal pain Obstruction Irritable bowel syndrome Excessive flatus Carbohydrate malabsorption Leakage of stool Fecal incontinence (consider occult constipation) Ask about family history Congenital absorptive defects Inflammatory bowel disease Coeliac disease Multiple endocrine neoplasia Ask about dietary History Sugar-free foods: Fructose, sorbitol or mannitol ingestion Excessive juice: Osmotic diarrhea /chronic non-specific diarrhoea Raw milk: Brainerd diarrhoea Exposure to potentially impure water source: Chronic bacterial infections (e.g. Aeromonas), giardiasis, cryptosporidiosis, Brainerd diarrhoea. Ask about travel history Infectious diarrhoea Chronic idiopathic secretory diarrhoea. Ask about past medical history Failure to thrive/weight loss Malabsorption, Pancreatic exocrine insufficiency, Anorexia nervosa. Immune problems HIV disease, Immunoglobulin deficiencies Ask about previous therapeutic interventions (drugs, radiation, surgery, antibiotics) Drug side effects Radiation enteritis Post-surgical status Pseudomembranous colitis (C. Difficile) Post-cholecystectomy diarrhoea Ask about secondary gain from illness Laxative abuse Ask about systemic illness symptoms Hyperthyroidism Diabetes Inflammatory bowel disease Tuberculosis Mastocytosis Ask about social history Intravenous drug abuse, sexual promiscuity (in adolescent/child’s parent) HIV disease Physical examination: Vital signs Heart rate and blood pressure are key predictors of dehydration. Tachycardia with a low blood pressure = severe hypovolemia Hypotension is a late finding in the child with hypovolemia. In older children, orthostatic hypotension should be assessed. Weak pulses support the finding of dehydration. Change in Weight If records of previous weight present, the estimation of the volume deficit is easier. Growth chart, muscle bulk (mid-arm circumference), subcutaneous fat (triceps skin-fold thickness) are also assessed. Mental status A child that is inconsolably crying / irritable or a lethargic...

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