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Forum Name: Pediatric Topics

Question: Ongoing GI symptoms & Abnormal Blood Tests in 7 yr. old


 HCG91570 - Sun Jan 01, 2006 11:51 am

Can anyone can shed any light on the following test results? Pt. is a 7 yr. old male with chronic GI symptoms (acute vomiting on ocassion, daily "stomach pain," formerly Dx'd with "functional bowel disease). Pts. blood tests since 1999 have constantly returned a high platelet count (614 in June 2003, 461 in Dec 2005). Other abnormalities on Dec 05 blood test include high neutrophils (71.8), low lymphs (19.5), low sodium (133), "significant changes" in HGB and HCT (frame of reference unavailable; current results are 14.3 HGB and 41.9 HCT), and high RDW (15.3). Pt. is in 95th% for height but has dropped from 75th% to 50th% for weight in 4 mos. time. Child was born at 36 weeks via induction due to mother's pre-eclampsia and has exhibited "stomach problems" since birth. Intersusseption of bowel was ruled out at 6 mos. of age but stomach problems have never been resolved. Dx. testing (U/S, barium MRI and stool samples) reveal no obvious abnormalities. Any thoughts on what to further test or look for in this child?? Thanks in advance!
 Dr. Heba Ismail - Fri Jan 06, 2006 8:22 am

First can you please tell us of any other symptoms as constipation, diarrhea, and describe the nature and site of abdominal pain. Also, has the stools been examined for the presence of occult blood?
 HCG91570 - Fri Jan 06, 2006 9:59 am

Thank you, Dr. Ismail...the child suffers from mild constipation and has a small hemmoroid. Diarrhea is very infrequent. Fecal occult studies negative for blood. Child describes pain as "lightening in his stomach" and at other times as pain that "takes his breath away." He indicates the site primarily to be from the bottom of the ribs to the umbilicus...GERD and similar disorders have been ruled out through a course of medical therapy. Also does not meet criteria for celiac disease. Child has been unable to take any dietary, therapeutic or lifestyle measures that successfully relieve the pain. Thanks again in advance for any advice!
 Dr. Heba Ismail - Fri Jan 13, 2006 7:24 am

Ok, sounds like it is a functional or non-organic pain. But just to be sure, is this pain ever disabling, meaning does it stop him during pleasurable activities and playing, or wake him up at night?
 HCG91570 - Fri Jan 13, 2006 8:13 am

Good morning, Dr. - Yes, the pain interferes with his school and normal activities and had begun waking him up at night on a regular basis. Often he must stop what he is doing immediately and lay down "curled up" until the pain subsides. It does not seem to be made worse by any particular activity or food intake and meds (Prevacid, etc.) do not relieve it. The durations of pain are daily, random and last approximately an hour or so. Once the pain passes, he resume normal activities but the pain returns on a regular, daily basis. Thank you for your thoughts and insight.

[quote="Dr. Heba Ismail"]Ok, sounds like it is a functional or non-organic pain. But just to be sure, is this pain ever disabling, meaning does it stop him during pleasurable activities and playing, or wake him up at night?[/quote]
 Dr. Heba Ismail - Fri Jan 13, 2006 8:23 am

Then you may need to consider a re-evaluation by another doctor. You may even need to repeat the studies done.
 HCG91570 - Fri Jan 13, 2006 8:25 am

Many, many thanks...I greatly appreciate your input and consideration. I am grateful for your time and expertise. Thanks again! =)
[quote="Dr. Heba Ismail"]Then you may need to consider a re-evaluation by another doctor. You may even need to repeat the studies done.[/quote]

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