LEARNER OBJECTIVES
At the completion of this chapter, the learner will be able to:
Section 1: Recurrent Abdominal Pain
1.1 Define recurrent abdominal pain in children three years of age or older.
1.2 Describe the clinical presentation of recurrent abdominal pain, including
history, physical exam, and psychosocial factors.
1.3 Explain the common organic causes of abdominal pain in children.
1.4 Identify features of the history and physical exam that are not consistent with
functional pain and suggest an organic basis for recurrent abdominal pain.
1.5 Discuss the pathophysiology and treatment of recurrent abdominal pain in children.
Section 2: Vomiting and Regurgitation
2.1 Discuss the factors related to diagnosing the vomiting child, including history
causes as related to age of presentation, examination, and diagnostic tests.
2.2 Explain management of the vomiting child.
2.3 Define gastroesophageal reflux disease (GERD).
2.4 Discuss complications associated with GERD as related to children.
2.5 Explain management of children with GERD.
Section 3: Colic
3.1 Define colic and outline its etiology, history, and management.
Section 4: Chronic Constipation, Encopresis and Soiling
4.1 Define constipation and discuss its pathophysiology and etiology as related to
children.
4.2 Discuss the differentiating features of functional constipation and aganglionic
megacolon.
4.3 Describe treatment for constipation (exclusive of specific therapy for organic
causes).
Section 5: Growth Failure and Malnutrition
5.1 Define failure to thrive and malnutrition.
5.2 Explain the diagnostic categories for failure to thrive.
5.3 Describe methods used for assessment and management of failure to thrive.
Section 6: Acute Diarrhea in Children
6.1 Explain the pathophysiology of acute diarrhea in children.
6.2 Describe the clinical assessment of acute diarrheal illness, including history,
physical examination, and degree of dehydration.
6.3 Discuss the management of children with acute diarrhea, including oral
hydration, early refeeding, and use of medication.
Section 7: Malabsorption
7.1 Define malabsorption.
7.2 Discuss the physiology and pathophysiology of digestion and absorption in
children.
7.3 Describe diagnostic procedures for diagnosing malabsorption, including dietary
record, growth parameters, and the plotting of growth curves.
7.4 Explain concepts of basic management of the child who presents with
malabsorption.
Section 8: Cystic Fibrosis
8.1 Discuss the GI manifestations of cystic fibrosis as related to children.
Section 9: Approach to the Jaundiced Neonate
9.1 Describe factors contributing to physiological jaundice in the newborn.
9.2 Discuss the causes of unconjugated hyperbilirubinemia in infancy.
9.3 Describe management of unconjugated hyperbilirubinemia in the infant.
9.4 Discuss the causes of conjugated hyperbilirubinemia in infancy.
9.5 Explain management of conjugated hyperbilirubinemia in the infant.
LEARNER WORKBOOK
EXERCISE 1
1.0 What is recurrent abdominal pain in children three years of age or older?
1.1 What will a child with recurrent abdominal pain complain about? List at least six
symptoms.
1.2 What psychosocial factors have been attributed to children with recurrent
abdominal pain?
1.3 List five common organic causes of abdominal pain in children.
1.4 What features of the history and physical exam would suggest an organic basis
for the abdominal pain?
1.5 How is the child with recurrent abdominal pain treated?
EXERCISE 2
2.0 List five features of the history that are helpful in reaching a diagnosis with a
vomiting child.
2.1 List six causes of vomiting for the:
a. Neonate/infant
b. Child/adolescent
2.2 Why is it important to plot the height and weight of a child who is or has been
vomiting?
2.3 An acutely ill febrile neonate requires different investigation than an older child.
What tests would help in diagnosing the neonate?
2.4 How is the vomiting child treated?
2.5 Why is feeding history important in the child who is vomiting or refluxing?
2.6 Briefly discuss three complications of gastroesophageal reflux as related to
children.
2.7 How is the child with gastroesophageal reflux managed?
EXERCISE 3
3.0 What is colic?
3.1 Briefly describe the etiology, history, and management of a child with colic.
EXERCISE 4
4.0 Define constipation as related to a(n):
a. Infant
b. Toddler
c. Preschooler
d. Older child
4.1 For a child who presents having difficulty with elimination, how would the
physician determine if the problem is functional, organic, or a parental
misinterpretation of symptoms?
4.2 What are the differentiating features of functional constipation and aganglionic
megacolon?
4.3 How is the child with constipation treated (excluding specific therapy for organic
causes)?
EXERCISE 5
5.0 What is the difference between failure to thrive and malnutrition?
5.1 Describe the three diagnostic categories for failure to thrive in children.
5.2 A useful diagnostic approach recognizes three types of failure to thrive according
to the deviance of head circumference, height, and weight. Explain each according
to type I, type II, and type III.
5.3 How is the infant with failure to thrive assessed?
5.4 How is the infant with failure to thrive managed?
EXERCISE 6
6.0 Briefly explain the pathophysiology of acute diarrheal disease in a child.
6.1 Fill in the following table:
Dehydration assessment and management:
Degree of
Dehydration |
General |
Thirst |
Eyes |
Mouth |
Skin |
Urine |
Rehydration
within 4 hrs |
None; < 2%
|
Mild; 3-5%
|
Moderate; 6-9%
|
| Severe; > 10% |
6.2 How is the child with acute diarrhea managed? Discuss the following three
methods.
a. Oral hydration
b. Early refeeding
c. Use of medications
EXERCISE 7
7.0 What is malabsorption in the child?
7.1 The normal process of intestinal digestion can be divided into three phases.
Briefly describe these three phases.
7.2 Briefly describe carbohydrate, protein, and fat digestion as related to the infant.
7.3 Briefly describe the diagnostic procedures for diagnosing malabsorption,
including dietary history, growth parameters, and the plotting of growth curves.
7.4 What laboratory tests are important in diagnosing malabsorption?
7.5 What are the basic principles of management of the child who presents with
malabsorption?
EXERCISE 8
8.0 What are the gastrointestinal manifestations of cystic fibrosis in a child?
EXERCISE 9
9.0 List six factors contributing to physiological jaundice in the neonate.
9.1 a. List ten causes of unconjugated hyperbilirubinemia in infancy.
b. How is unconjugated hyperbilirubinemia managed?
9.2 a. List ten causes of conjugated hyperbilirubinemia in infancy.
b. How is conjugated hyperbilirubinemia managed?
