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Diseases » Short Bowel Syndrome » Diagnosis

Diagnosis of Short Bowel Syndrome

Short Bowel Syndrome Diagnosis: Book Excerpts

Diagnostic Tests for Short Bowel Syndrome: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Short Bowel Syndrome.

Short Stature: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Familial short stature
Constitutional delay of growth and puberty
Hypothyroidism
Growth hormone deficiency (GHD)
GH resistance (Laron syndrome)
Congenital hypopituitarism
–Secondary to brain tumors

Acquired hypopituitarism
–After irradiation, surgery, and chemotherapy for neoplasms
–Infectious
–Infiltrative
–Vascular

Cushing syndrome
Precocious puberty
–Tall initially
–Final height compromised
Pseudohypoparathyroidism
Rickets
Genetic syndromes
–Turner syndrome
–Down syndrome
–Noonan syndrome
–Prader-Willi syndrome
Intrauterine growth retardation
–Silver-Russell syndrome
Disorders of bone development
–Achondroplasia/hypochondroplasia
–Chondrodystrophies
Psychosocial deprivation
Malnutrition
Chronic drug intake
–Glucocorticoids
–Methylphenidate
Infectious
–HIV
–Tuberculosis
Congenital heart disease
Gastrointestinal
–Celiac disease
–Inflammatory bowel disease
–Chronic liver disease
Pulmonary
–Cystic fibrosis
Chronic renal disease
–RTA
–Renal failure
Skeletal disorders

Workup and Diagnosis

History
–Neonatal hypoglycemia or jaundice, brain tumor or other malignancy and treatment, central nervous system infection, nutrition status, chronic illness

Family history
–Parents’ heights and puberty ages to judge child's growth relative to genetic potential (midparental target height), family history of chronic disease or endocrinopathy

Physical exam
–Anthropometrics (height, weight, sitting height), dysmorphic features, craniofacial midline abnormalities (pituitary disease), dentition maturation (delayed in hypothyroidism), chronic illness, Tanner staging for pubertal assessment, micropenis in boys (growth hormone deficiency)

Bone age X-ray to evaluate skeletal maturation

Labs
–CBC with differential cell count, LFT, BUN, Cr, electrolytes
–ESR, TSH, T4
–Growth factors (IGF-I, IGFBP-3)
–Celiac antibody panel (anti-tissue transglutaminase)
–Karyotype in girls to rule out Turner syndrome

If IGF-I and/or IGFBP-3 low, provocative growth hormone test to confirm GHD (must fail two tests)
MRI of the brain with special cuts of the pituitary in any child diagnosed as having GHD

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Shortness of Breath: History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

Are historical features helpful? Historical findings are neither sensitive nor specific; however, some symptoms are associated with specific diseases. Regardless of the cause, people associate shortness of breath with words that describe a sense of “work” or “effort” to breathe. Asthma is associated with words that denote a sense of “tightness.” Patients with interstitial lung disease choose terms emphasizing the sense of “rapid” breathing. Did the patient select terms indicating difficulty with both inhalation and exhalation? This is often reported by patients with CHF (Chapter 7.5). Patients who are deconditioned select rapid, breathing more, or heavy to describe their dyspnea. Patients suffering from neuromuscular disorders select terms denoting rapid breathing or difficulty with inhalation. Is the patient aged less than 40 years? Are the patient’s symptoms episodic? Reactive airway disease and hyperventilation are associated with these terms (2).

Physical examination

In the physical examination, focus on signs of respiratory or cardiac disease. For the respiratory system, this means a careful examination starting at the nose. Specifically, on head, eyes, ear, nose, and throat examination look for evidence of obstruction, infection, or postnasal drip. Exclude obstruction, subcutaneous emphysema, or tracheal deviation. On cardiac examination, look for evidence of cardiomegaly, S₃ gallop, or hepatojugular reflux (HJR). In this setting, HJR is very specific for CHF (1). Assess the lungs for abnormal breath sound intensity, rales, wheezing, rhonchi, or tachypnea. Examine the chest for abnormal movements or deformities. Exclude abdominal masses, ascites, pregnancy, or abdominal distention. Evaluate the extremities for edema, tenderness, or asymmetry. Do a complete neurologic examination, and screen for weakness atrophy, sensory loss, and fasciculations.

» READ BOOK EXCERPT ONLINE »

Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000