Examkin

Soru

Zorluk: OrtaPediatric Gastrointestinal Disorders

A 2-year-old boy is brought to the emergency department by his parents after they found a large amount of maroon-colored stool in his diaper. The parents report that the child has had no episodes of emesis, diarrhea, or apparent abdominal pain. He has been active and playing normally at home today. His medical history is unremarkable, and his immunizations are up to date. His temperature is 36.9°C (98.4°F), heart rate is 112/min, respiratory rate is 22/min, and blood pressure is 92/58 mm Hg. On physical examination, the child appears comfortable and in no acute distress. The abdomen is soft, non-tender, and non-distended, with no palpable masses. Bowel sounds are active. Inspection of the perianal area shows no fissures. Laboratory studies reveal a hemoglobin of 10.2 g/dL and a mean corpuscular volume of 78 fL. Which of the following is the most appropriate next step in evaluating this patient's condition?

  1. Technetium-99m pertechnetate scintigraphyCevap
  2. B
    Abdominal ultrasonography
  3. C
    Computed tomography scan of the abdomen
  4. D
    Colonoscopy
  5. E
    Administration of empiric intravenous antibiotics

Cevap

Technetium-99m pertechnetate scintigraphy
The correct answer is Technetium-99m pertechnetate scintigraphy, commonly known as a Meckel scan. This patient's presentation of massive, painless lower gastrointestinal bleeding (maroon-colored stools) in a toddler with a completely normal physical examination is classic for a bleeding Meckel diverticulum. The bleeding occurs because the diverticulum often contains ectopic gastric mucosa that secretes hydrochloric acid, causing ulceration of the adjacent normal ileal mucosa. The Technetium-99m pertechnetate isotope has a high affinity for gastric mucosa, making it the most accurate non-invasive test to diagnose this condition.

Adım Adım Çözüm

1
Analyze the clinical presentation
The patient is a 2-year-old with painless lower gastrointestinal bleeding (maroon stools) and mild anemia, with normal vital signs and a benign abdominal exam.
Identifying the key features (age, painless bleeding, no systemic symptoms) is crucial for formulating a differential diagnosis.
2
Determine the most likely diagnosis
Meckel diverticulum is the most likely cause of painless hematochezia in a toddler.
The rule of 2s for Meckel diverticulum often applies: it classically presents around 2 years of age with painless bleeding due to ectopic gastric mucosa ulcerating adjacent normal tissue.
3
Select the appropriate diagnostic test
A Technetium-99m pertechnetate scan (Meckel scan) is the diagnostic test of choice.
The scan specifically identifies ectopic gastric mucosa, which is responsible for the bleeding in symptomatic Meckel diverticulum.

Anahtar Kavram

Meckel diverticulum classically presents as painless lower gastrointestinal bleeding in young children and is diagnosed using a Technetium-99m pertechnetate scan.
Bu soruyu puanla

Konular

Pediatric Gastrointestinal Disorders

Bu konudan daha fazla soru