| A. give her mineral oil 3 times a day |
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0 |
0% |
| B. advise him to give her prune juice or pear juice |
Kamsi, hanwin, thuang, neuroblastoma, gr8doc, starcraftbw |
6 |
38% |
| C. determine thyroid-stimulating hormone levels |
dermatology, Jasz98 |
2 |
13% |
| D. order a barium enema |
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0 |
0% |
| E. order rectal manometry and a rectal biopsy |
Justice, almond_52 |
2 |
13% |
| F. reassure him |
dr in trouble, liliaeliz, hgheith, dr penicillin, Adam |
5 |
31% |
| Author | 25 Posts |
skinyballs
Forum Junior
Topics: 14
Posts: 26
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An 8-month-old infant, who you have been taking care of since he was born at the local community hospital, is brought to the office because of constipation. The father, a "stay-at-home dad," tells you that she has been having 1 bowel movement every 3-4 days, and that the stool is always very hard. He says that she is doing very well otherwise; she is a very happy and easy little girl. She is fed primarily infant formula and he is starting to introduce solid foods. He says that he is concerned because he remembers always having to change "very dirty" diapers for both of his other children, at least twice a day. Physical examination is unremarkable. A rectal examination shows guaiac negative brown stool. The most appropriate next step is to
A. advise him to give her mineral oil 3 times a day until she is "regular"
B. advise him to give her prune juice or pear juice
C. determine thyroid-stimulating hormone levels
D. order a barium enema
E. order rectal manometry and a rectal biopsy
F. reassure him that all infants have different bowel habits
Edited by new_n_lost on 09/03/07 - 01:16 PM. Reason: Ads Not Allowed in Posts
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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F. Each pte has different bowel habits, and also young child whom had been introducing new diet could present some bowel habit change.
Constripation for 3-4 days without any other symptom, I think it is normal.
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| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
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I think this is classic Hirschsprung's disease...
The problems usually start what solid meal is introduced...
The diagnosis is made by E. order rectal manometry and a rectal biopsy
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| hallachi
Forum Junior
Topics: 11
Posts: 63
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In hirschspring..there is symptoms since birth...plus there is no family history ..other children have normal bowl habits...snd in rectum is full of brown guanic -ve stool ...is least likely to be hirschspring.
I will go with F) reassurence
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| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
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hallachi wrote:
In hirschspring..there is symptoms since birth...plus there is no family history ..other children have normal bowl habits...snd in rectum is full of brown guanic -ve stool ...is least likely to be hirschspring.
I will go with F) reassurence
In Hirsch D family history is seen in ~10% of cases...
Age of presentation depends upon the length of aganglionic segment of bowel
Do not quite understand the reasoning regarding guaiac (-) stool... Should these kids have blood in stool???
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| skinyballs
Forum Junior
Topics: 14
Posts: 26
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I think is not Hirschprung
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| skinyballs
Forum Junior
Topics: 14
Posts: 26
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mmmmm.......
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| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
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After rereading the Q I actually don't see reference to recent onset of the problem: "...The father, a "stay-at-home dad," tells you that she has been having 1 bowel movement every 3-4 days, and that the stool is always very hard..."... No pediatricians would say that this is normal for a 8-mo child to stool once in 4 days...
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| Kamsi
Forum Guru
Topics: 103
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FRuit juice . This is constipation .It's not normal for the child to move bowel once in 3 to 4 daysand hard.This usually happens to formular fed b/c of decreased fluid intake umlike in breastfed which contains whole lot of water.Fruit juices should be given .It'll help in moving the bowel
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| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
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Kamsi wrote:
FRuit juice . This is constipation .It's not normal for the child to move bowel once in 3 to 4 daysand hard.This usually happens to formular fed b/c of decreased fluid intake umlike in breastfed which contains whole lot of water.Fruit juices should be given .It'll help in moving the bowel
I disagree with this. Formulas are made as #of metered spoons per volume, to maximize the likelihood of the prep to the composition of breast milk... And children are fed based on the VOLUME that they are supposed to receive multiplied by the number of times of feeding (they say it is done as many times are the child wants to eat, but it anyway happens every 2-3 hr) not the weight of the protein or fat in formula or breast milk. Some parents make a full bottle of formula and allow a child to eat as much as they want… I do not see any sign of hypovolemia and dehydration that would suggest insufficient volume of water… This is an otherwise healthy child without any signs of paratrophy…
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| dr in trouble
Forum Guru
Topics: 62
Posts: 610
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But this is right that the infants on formula feed experience constipation more in contrast to breast fed infants.
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| liliaeliz
Forum Elite
Topics: 41
Posts: 373
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"F " I dont think hirsprung (abdominal distention, bilious vomiting, failure to pass meconium,failure to drive====B enema=== rectal biopsy
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| dr19
Forum Senior
Topics: 12
Posts: 120
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B
ps lease transfer it to pediatrics section.
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| almond_52
Forum Newbie
Topics: 4
Posts: 17
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no doubts any more right answer is e
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| kpmle2
Forum Guru
Topics: 77
Posts: 454
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B. advise him to give her prune juice or pear juice
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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skinyballs, What is the answer, pls?
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| dermatology
Forum Elite
Topics: 30
Posts: 297
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why not see whether kids got cong . hypothyroidism ?????
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| gr8doc
Forum Senior
Topics: 8
Posts: 210
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It is constipation secondary to iron fortified formula feed, so give the kid prune juice or pear juice. She'll do fine.
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| me007
Forum Guru
Topics: 72
Posts: 799
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why not D?
barium enema to see if there is an abnormal distention, if yes - biopsy, if no - fruit juice.
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| epica
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No, D is incorrect
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| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
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skinyballs,
do you have answer to this Q?
thank you
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| hgheith
Forum Elite
Topics: 39
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I havne't started studying peds yet, but my baby had the same problem when he was 3 months and was only formula fed, doctor said it was normal. I would assume it be the same for this baby b/c dad just started infant food. so I would say B answer The other problems would have shown up at or after birth, and this baby was doing fine till now
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| starcraftbw
Forum Senior
Topics: 13
Posts: 166
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looks like B is winning haha
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| hgheith
Forum Elite
Topics: 39
Posts: 268
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So do you have an answer ??
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| Dr.D
Forum Senior
Topics: 22
Posts: 191
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skinyballs, What is the answer?
B
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