Differential DDx from PEDs:
-Ovarian Cyst
-Renal Calclui
-Peptic Ulcer Disease
-Addison's Disease
-Acute Kidney Injury
-Bowel Obstruction
-Pancreatitis (Acute and Chronic)
-Diverticulitis
-Superior Mesenteric Artery Syndrome
-Ulcerative Colitis

New DDx:
Bacterial infection? (H.Pylori?)
Indigestion?
IBS?
Hiatal hernia?
Ulcers?

Eliminated:
-Acute kidney Injury
-Renal Calculi
-Addisons disease

Colonoscopy: look for redness, irritation inside the bowel, can indicate Ulcerative Colitis; also able to visual any polyps, tumors, or obstructions, etc.

very detailed look at abdomen to view any abnormalities

detailed view of upper GI tract; esophagus, stomach, duodenum

can obtain fine needle aspiration biopsies of suspicious areas in pancreas, liver, ducts

view abnormalities including: obstructions, inflammation, perforations, malignancies, hernias

Pt may have severe electrolyte abnormalities due to the recurrent vomiting

A CT abdomen is warranted because of the profound abnormal symptoms on physical exam (epigastric tenderness, distendid, hyperactive bowel sounds). Additionally, the patient meets SIRS criteria so it is important to do investigations to find the sourse of infection

The results of the ABG are useful because they show a metabolic alkalosis and decreased PaO2.

Ulcerative colitis (UC) is an idiopathic inflammatory condition of the large intestine which results in erosions of the colonic wall and inflammation of the mucus and submucosa of the colon (Lynch & Hsu, 2023). In patients with UC, T cells accumulate in the lamina propria of the diseased colon segment (Basson, 2023). The T cells are cytotoxic to the colonic epithelium (Basson, 2023). There is also an increase in anti colinic antibodies, B cells, plasma cells, and increased production of IgG and IgE (Basson, 2023). Additionally, there is a defect in colonic mucin which leads to an increased uptake of luminal antigens (Lynch & Hsu, 2023). UC can also result in an imbalance between microflora and the host mucosal immunity which results in and abnormal response to non-pathogenic bacteria (Lynch & Hsu, 2023).

The main onset occurs between the ages of 15 and 30 years old (Lynch & Hsu, 2023). The patient is 18.

UC is slightly more common in women than men (Basson, 2023).

(+) stool guaiac which indicates bleeding in the GI tract which could be due to inflammatory bowel (Basson, 2023).

The inflammation can trigger other immune responses in the body such as arthritis, eye inflammation, or skin inflammation (Lynch & Hsu, 2023).

Patho: Ingested fluid and food, digestive secretions, and gas accumulate above the obstruction(Ansari, 2023). The proximal bowel distends, and the distal segment collapses(Ansari, 2023) The normal secretory and absorptive functions of the mucosa are depressed, and the bowel wall becomes edematous and congested(Ansari, 2023) Severe intestinal distention is self-perpetuating and progressive, intensifying the peristaltic and secretory derangements and increasing the risks of dehydration and progression to strangulating obstruction(Ansari, 2023).

Patient does not have hyperalbuminemia, hypokalemia, or hypomagensemia (Basson, 2023). Patient is not anemic.

Adhesions from previous surgery can form bands of fibrous tissue in the abdominal cavity (Intestinal Obstruction - Symptoms & Causes - Mayo Clinic, 2021)

may suggest strangulation obstruction (Small Bowel Obstruction, n.d.)

pressure from distended bladder may cause bowel obstruction (Papeš et al., 2013)

Peritonitis---infection in abdominal cavity; a life threatening condition that requires immediate medical attention and often surgery(Intestinal Obstruction - Symptoms & Causes - Mayo Clinic, 2021)

inserted into intestine to clear obstruction(Intestinal Obstruction - Diagnosis & Treatment - Mayo Clinic, 2021)

proper mouth care (sponges) to alleviate dryness (Tradounsky, 2012)

8-10 cups of water a day( Intestinal Obstruction Discharge Information - Tufts Medical Center Community Care, 2017)

low fiber diet to avoid cramping/bloating (Intestinal Obstruction Discharge Information - Tufts Medical Center Community Care, 2017)

exercise to keep bowels healthy and regulate digestive function

Patho: If left untreated, H. pylori infection initiates a slow carcinogenic process, developing over decades and eventually leading to antral-predominant chronic active gastritis and ultimately to multifocal atrophic gastritis, which is a risk factor for intestinal and, less commonly, diffuse gastric adenocarcinomas (Lauwers & Kumarasinghe, 2022). While H. pylori infection usually starts in infancy or early childhood, there is a long latency period, and cancers are clinically diagnosed four or more decades later (Lauwers & Kumarasinghe, 2022). During this period, a prolonged precancerous process takes place, represented by a "cascade" of sequential histopathologic stages: chronic active nonatrophic gastritis, multifocal atrophic gastritis, intestinal metaplasia (complete, then incomplete), dysplasia, and invasive carcinoma in a high-incidence area (Lauwers & Kumarasinghe, 2022).

Family History of Colon Cancer (Chan & Wong, 2023)

often patients will bowl obstructions have a fullness feeling and are unable to consume anything

Alcohol use (Chan & Wong, 2023)

Increased salt and nitroso compounds (Chan & Wong, 2023)

viewing the abdominal cavity to view possible tumors

Renal: Membranous nephropathy may occur, causing inflammation and leading to flank pain and decreased output (Mansfield, 2022).

Hematology/Pulmonology: can cause hemolytic anemia and hypercoagulable states; also developing pulmonary emboli (Mansfield, 2022).

unnecessary tests or redundant tests were eliminated from case

our proposed solutions aligned with the actual solutions quite closely.

We had a good grasp of the facts of this case and were not led astray by unimportant details. From the beginning, we predicted that the actual diagnosis was in fact, a bowel obstruction related to adhesions.

Yes. we collaborated well and made sure to take all aspects of the case into consideration. We were successful in our application of our knowledge to uncover the case.

If this was a pediatric patient, appendicitis and cholecystitis could have made it on the differential because they likely would still have those respective organs

Ideally, financial status should not impact our plan of care. However, we should always be conscious of not ordering unnecessary tests if those differential diagnoses can be ruled out by costless, physical exams

Management of diseases is different in the pediatric population because we have to be conscious of dosage differences depending on body weight

We need to ensure that we provide age-appropriate education so the patient knows what signs and symptoms they should notify an adult if they experience

Intussusception might have made the list of differential diagnoses as it can cause severe abdominal pain with vomiting

Ask if they want to play. If the child's stomach hurts and doesn't want to play this may mean they are in a lot of pain.

We reviewed the feedback and case updates throughout the week and added to our Coggle. I think we did a good job expanding upon our diagnoses with new assessments and information,

We had SBO as one of our final top 4 diagnoses, so we were not down the completely wrong path. We did consider other conditions that the stomach (Gastric cancer and PUD) and the large intestine (UC) instead of the small intestine.

We should remember to ask about all at home medications and supplements.