08-04-2006, 10:42 AM
An 8-year-old girl is brought to the office because she has been complaining of frequent
abdominal pain. The episodes of pain occur every several days, show no particular pattern,
and resolve without treatment within 10-15 minutes. During the episode, the child has to lie
down and bring her legs up to her chest for relief. The parents tell you that she started having
this problem approximately a year earlier and they believed it was related to her diet, but after
trying to restrict various kinds of food with no effect, they decided to have her examined. Her
bowel movements are regular. She has no significant past medical history and takes no
medication on a regular basis. She has an older brother who is in excellent health. The mother
tells you that she loves school and is a very good student. She is very popular among her
friends and has no problems in social relationships. Of interest, they had immigrated to the
United States 3 years earlier and had moved three times since then because of her parents'
jobs. She did not seem to have any trouble adjusting to that situation. They will be moving to
another city again in 6 months. On physical examination, the girl is in no acute distress. She is
in the ninetieth percentile for height and weight and her vital signs are within normal limits, as
is a complete blood count with white blood cell differential. Her abdomen is not distended and
is soft and nontender to palpation. Plain abdominal films show no abnormalities. Which of the
following statements about this patient is the most accurate?
A. A computerized tomography scan of the abdomen is indicated
B. A trial of oral antibiotics is warranted
C. Stool cultures are not indicated at this time
D. She is likely to continue having episodes of abdominal pain even as an adult
E. She may have Hirschsprung disease and a biopsy of the colon is indicated
F. A barium enema is indicated at this time
abdominal pain. The episodes of pain occur every several days, show no particular pattern,
and resolve without treatment within 10-15 minutes. During the episode, the child has to lie
down and bring her legs up to her chest for relief. The parents tell you that she started having
this problem approximately a year earlier and they believed it was related to her diet, but after
trying to restrict various kinds of food with no effect, they decided to have her examined. Her
bowel movements are regular. She has no significant past medical history and takes no
medication on a regular basis. She has an older brother who is in excellent health. The mother
tells you that she loves school and is a very good student. She is very popular among her
friends and has no problems in social relationships. Of interest, they had immigrated to the
United States 3 years earlier and had moved three times since then because of her parents'
jobs. She did not seem to have any trouble adjusting to that situation. They will be moving to
another city again in 6 months. On physical examination, the girl is in no acute distress. She is
in the ninetieth percentile for height and weight and her vital signs are within normal limits, as
is a complete blood count with white blood cell differential. Her abdomen is not distended and
is soft and nontender to palpation. Plain abdominal films show no abnormalities. Which of the
following statements about this patient is the most accurate?
A. A computerized tomography scan of the abdomen is indicated
B. A trial of oral antibiotics is warranted
C. Stool cultures are not indicated at this time
D. She is likely to continue having episodes of abdominal pain even as an adult
E. She may have Hirschsprung disease and a biopsy of the colon is indicated
F. A barium enema is indicated at this time