03-15-2011, 07:16 PM
24.
A previously healthy 13-year-old girl is brought to the physician because of a 2-month history of intermittent abdominal pain and loose stools. She has had a 2.3-kg (5-lb) weight loss during this period due to a decreased appetite, but she drinks up to 1 liter of fruit juice daily. At her last visit 9 months ago, she was at the 50th percentile for height and the 50th percentile for weight. She is now at the 50th percentile for height and the 10th percentile for weight. Her temperature is 37.8 C (100 F), pulse is 80/min, and respirations are 18/min. Examination shows no other abnormalities. Test of the stool for occult blood is positive. Laboratory studies show:
Hemoglobin 8.5 g/dL
Leukocyte count 9100/mm3
Segmented neutrophils 55%
Lymphocytes 35%
Monocytes 10%
Platelet count 650,000/mm3
Erythrocyte sedimentation rate 75 mm/h
Serum
Na+ 139 mEq/L
Cl– 101 mEq/L
K+ 3.2 mEq/L
HCO3– 23 mEq/L
Urea nitrogen (BUN) 8 mg/dL
Glucose 73 mg/dL
Creatinine 0.2 mg/dL
A barium enema shows patches of ulcerations along the proximal colon with reflux of dye into the terminal ileum. Which of the following is the most appropriate next step in management?
A) Eliminate fruit juice from the patient's diet
B) Switch to a gluten-free diet
C) H2- receptor blocking agent therapy
D) Prednisone and aminosalicylate therapy
E) Bowel resection
A previously healthy 13-year-old girl is brought to the physician because of a 2-month history of intermittent abdominal pain and loose stools. She has had a 2.3-kg (5-lb) weight loss during this period due to a decreased appetite, but she drinks up to 1 liter of fruit juice daily. At her last visit 9 months ago, she was at the 50th percentile for height and the 50th percentile for weight. She is now at the 50th percentile for height and the 10th percentile for weight. Her temperature is 37.8 C (100 F), pulse is 80/min, and respirations are 18/min. Examination shows no other abnormalities. Test of the stool for occult blood is positive. Laboratory studies show:
Hemoglobin 8.5 g/dL
Leukocyte count 9100/mm3
Segmented neutrophils 55%
Lymphocytes 35%
Monocytes 10%
Platelet count 650,000/mm3
Erythrocyte sedimentation rate 75 mm/h
Serum
Na+ 139 mEq/L
Cl– 101 mEq/L
K+ 3.2 mEq/L
HCO3– 23 mEq/L
Urea nitrogen (BUN) 8 mg/dL
Glucose 73 mg/dL
Creatinine 0.2 mg/dL
A barium enema shows patches of ulcerations along the proximal colon with reflux of dye into the terminal ileum. Which of the following is the most appropriate next step in management?
A) Eliminate fruit juice from the patient's diet
B) Switch to a gluten-free diet
C) H2- receptor blocking agent therapy
D) Prednisone and aminosalicylate therapy
E) Bowel resection