pram
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An 8 month baby who was previously well now presents with loss of wt,vomiting, and passage of pale .loose and offensive stools.Which of the following is true
a-Giardisis is ruled out if not found on stool exam by microlab expert.
b-Metronidazole trial is warranted.
c-Barium follow thru will establish diagnosis.
d-Diagnosis by intestinal biopsy.
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| shumaila
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hmmm b???
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| pram
Forum Senior
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I am just wondering Whether it is Coeliac disease or due to Giardia lamblia.
Then Answer is no problem because Coeliac disease starts presenting at 6 month age and but giardia can occur at any age.
Also wt loss at 8 month might be Coeliac has started 2 months ago.
No temperature
but in Giardia also may be asyptomatic or afibrile.
So important is to reach at correct diagnosis .then options are wasy to choose.
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| juanma0
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A, but just because itīs true.
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| study_ing
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but isnt there a fancy string test for giardia..if the stool was enough, y wud we have that?
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| study_ing
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"In summary, stool O&P tests aid in the diagnosis of giardiasis in 80-85% of patients. If the results from the 3 O&P tests are negative and the disease is still suspected, stool antigen enzyme-linked immunosorbent assay (ELISA) may be helpful. If both of these methods result in negative findings but the patient has symptoms consistent with small bowel diarrhea/malabsorption, upper endoscopy with biopsies and duodenal aspirate is a reasonable alternative"
http://www.emedicine.com/MED/topic868.htm#section...
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| juanma0
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Ok, so answer is D??
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| study_ing
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for an 8 month old...how abt a tria l of metro
frankly, i dunno the answer
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| frank100
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no vomiting in celiac disease, giardia does.
b. metronidazole trial is not warranted, because the definitive diagnosis (stool for ova and parasites) have not been done yet. you donīt treat unless necessary or not sure of the diagnosis, which is not the case here.
If you treat empirically this type of diarrhea, you can be missing something else.
c.definitely not
d. no chronicity in the history is suggested. you sample for celiac disease, only when you have a huge suspicion of celiac disease...
my answer is (A) because itīs a true statement, and stool for ova and parasites must be positive for the diagnosis. he still has a watery stool, which makes it a good time to study. once the stool is formed or semiformed, it is very hard to find the trophozoites.
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| study_ing
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cud u plz cite the reference for a.. i understand emedicine is not a higly valued source.
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| DR.HANI
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hi guys!
the answer is D ... THE CHRONICITY is sugested by wt loss ... for 'A' check out this :
"One negative result does not rule out the possibility of parasitic infestation. Stool examination for Giardia may be negative in early stages of infection, in patients who shed organisms cyclically, and in chronic infections.1 The sensitivity of microscopic methods for the detection of Giardia range from 46% to 95%.2 Tests for Giardia antigen may have a higher yield."
http://www.labcorp.com/datasets/labcorp/html/chap...
regards !
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| tolito
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how long does it take an 8mo old baby to loose weight? just 48hrs of loose stool is enough to drop teh weight drastically if the diarrhoea is severe enough. plus this child is vomitting, that is likely to be an acute thing in a previously well baby.
from info given above A may not be an accurate way to rule out giardia in the absece of the 'fancy' string test.
you lose nothing with a metro trial so why not.
intestinal biopsy is invasive and would not even diagnose all the causes of loose foul smelling diarrhoea in this baby.
so i vote for B.
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| doc68
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D!!!
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