GI: Patrick O’Donnell

Subjective

Patrick O’Donnell is a 22-month-old boy of Irish American descent. His mother has had concerns about loose stools for the past 3 to 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 four-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 for 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

See Growth Chart

Vital signs weight (10.8 kg/23 lb. 13 oz ), length (84 cm/33.25”), and temperature (97.6 ax). See the growth chart.

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 (Tissue Transglutaminase): 14.6 u/ml (ref: <4.0 is negative, 4 to 10 is weak positive, and >10.0 is positive)

Putting it all together: Answer all 4 questions based on the case study above:

Assessment and Plan

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, based on the given lab

results ( i.e., Celiac disease). Include diagnostic testing, consults, referrals, patient

education, and follow-up. Discuss the rationale for the measures contained in your plan, using peer-reviewed, evidence-based, and primary academic references to support your rationale.

References to use:

Garzon Maaks, D.L., Starr, N. B., Brady, M. A., Gaylord, N. M., Driessnack, M., Duderstadt, K. G. (2020). Burns’ Pediatric primary care (7th ed.). St. Louis, MO: Elsevier Science. ISBN-13: 978-0323581967

Finnell, S. M. E., Carroll, A. E., Downs, S. M.,&The Subcommittee on Urinary Tract Infection. (2011).Diagnosis and management of an initial UTI in febrile infants and young children.Pediatrics, 128(3), e749-e770. DOI: 10.1542/peds.2011-1332•

Subcommittee on Urinary Tract Infection. (2016). Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age.Pediatrics, 138(6), e20163026; DOI: 10.1542/peds.2016-3026