F. Functional Diarrhea
Must include all of the following 1.
Daily painless, recurrent passage of three or more large, unformed stools.
2.
Symptoms lasting more than 4 weeks.
3.
Onset of symptoms that begins between 6 and 36 months of age.
4.
Passage of stools that occur during waking hours.
5.
There is no failure to thrive if caloric intake is adequate.
Courtesy of the Rome Foundation.
Abnormal screening laboratory study (anemia, hypoalbuminemia,
Family history of inflammatory bowel disease, celiac disease, or therapy, amitriptyline, or a selective serotonin reuptakeinhibitor may be helpful. When significant anxiety or socialdysfunction persists, a mental health professional should beconsulted.
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Vomiting is a coordinated, sequential series of events that leads to forceful oral emptying of gastric contents. It is a common problem in children and has many causes. Vomiting should be distinguished from regurgitation of stomach contents, also known as gastroesophageal reflux (GER), chalasia, or “spitting up.” Although the end result of vomiting and regurgitation is similar, they have completely different characteristics. Vomiting is usually preceded by nausea and is accompanied by forceful gagging and retching. Regurgitation, on the other hand, is effortless and not preceded by nausea.
In neonates with true vomiting, congenital obstructive lesions should be considered. Allergic reactions to formula in the first 2 months of life may present with vomiting. Infantile GER (“spitting up”) occurs in most infants and can be large in volume, but is effortless and these infants do not appear ill. Pyloric stenosis occurs in the first months of life and is characterized by steadily worsening, forceful vomiting that occurs immediately after feedings. A visibly distended stomach, often with visible peristaltic waves, is often seen before vomiting. Pyloric stenosis is more common in male infants; the family history may be positive. Other obstructive lesions, such as intestinal duplication cysts, atresias, webs, and midgut
Determine degree of functional impairment (e.g., missing school) CBC ESR Amylase, lipase
Urinalysis Abdominal ultrasound—examine liver, bile ducts, gallbladder, pancreas, kidneys, ureters (move to follow up)
Trial of 3-day lactose-free diet CT scan of the abdomen and pelvis with oral, rectal, and intravenous contrast
Barium upper GI series with small bowel follow-through
Endoscopy of the esophagus, stomach, and duodenum
CBC, Complete blood count; CT, computed tomography; ESR, erythrocyte sedimentation rate; GI, gastrointestinal. *Consider using one or more of these to investigate warning signs, abnormal laboratory tests, or specific or persistent symptoms.
malrotation, should be considered. Metabolic disorders (e.g.,organic acidemias, galactosemia, urea cycle defects, adrenogenital syndromes) may present with vomiting in infants. Inolder children with acute vomiting, viruses and food poisoning are common. Other infections, especially streptococcalpharyngitis, urinary tract infections, and otitis media, commonly result in vomiting. When vomiting is chronic, centralnervous system (CNS) causes (increased intracranial pressure,migraine) must be considered. Cyclic vomiting syndrome or migraine may be the etiology of recurrent vomiting. Whenabdominal pain or bilious emesis accompanies vomiting, evaluation for bowel obstruction, peptic disorders, and appendicitismust be immediately initiated.