February Week 2: Malabsorption

Articles:

Pietzak M, et al. Childhood Malabsorption. Peds in Review. 2003;24(195-206).

Case 1:

You are seeing a 12 month old boy for a well visit. You note that he was 55th percentile for weight at his 9 month visit, but is now 13th percentile. In getting your history, you find that he has been having loose stools for the last several months.

What else do you want to ask? 
What will you look for on your exam? 
What is your next step?

He returns to see you 1 month later. His diarrhea has persisted and is very foul smelling and he is now less than 3rd percentile for weight.

What are the different categories of FTT? 
What is your differential diagnosis? 
Depending on what you are suspecting from your history and physical, what would your initial workup include?

His workup comes back consistent with celiac disease.

What is celiac disease? 
What groups of people have increased risk of celiac disease? 
Why did you order an IgA level? 
What advice do you give the parents? 
What is your next step in management?

Case 2:

A 10 mo old girl is brought in by mom and dad for an acute visit. She began vomiting 3 days ago, followed by diarrhea for the last 2 days. The vomiting resolved but parents report she is still having 2-3 stools every hour. They thought the diarrhea was improving yesterday so they switched back to her formula after having given her pedialyte for a couple of days. However they brought her in today because the diarrhea has worsened.

What is this patient’s diagnosis? 
What do you recommend to the parents for treatment?

Case 3:

You are seeing a 9 mo old girl who just moved to the US from El Salvador. Her parents bring her to your office because she has always had very loose foul smelling stools. They also tell you that she is “always sick” and has required hospitalization several times in El Salvador, although they don’t know why. You note that she is less than 3rd percentile for weight, and on exam she appears thin and mildly dehydrated, and has nasal congestion but lungs are clear. Her mom shows you a diaper filled with greasy foul smelling stool

What are you concerned about? 
What will you order next?