DIVINE WORD HOSPITAL

DEPARTMENT OF PEDIATRICS

SMALL GROUP DISCUSSION

Prerequisites
The students are expected to have adequate knowledge of the most
common diseases in children and have mastered the essentials of
history taking and physical examination of the patient seen at the
emergency room.

Course Outcome
At the end of the session, the student should be able to: Learn the
principles of diagnosis, pathophysiology, prevention of complications,
and management of a common disease in Pediatrics seen at the ER
setting presenting with abdominal pain.

Case
A.V., 9 years old, female from Calbayog City, Samar presents to the
emergency room because of abdominal pain. The abdominal started
about 1 month ago described to be dull, on and off, and poorly localized,
hence, no consult sought. Until few days PTA, now with associated
nausea and vomiting. Persistence of symptoms and increase in severity
of the abdominal pain prompted consult and subsequent admission. Her
mother is concerned because she seems to be losing weight despite
increased in appetite and noted occasional episodes of bedwetting
which the mother attributed to increase in daytime physical activity.

On PE, she is awake, afebrile, tired-looking and in mild cardiorespiratory

distress. Her vital signs are as follows: HR 120bpm, RR 38cpm. She had
pink conjunctivae, dry skin with tacky oral mucus membranes. She is
tachypneic with clear breath sounds. The abdomen is soft with
generalized tenderness with no hepatosplenomegaly. Neurologic
examination was normal.
Guide Questions:

1. What additional information in the history would you ask for and
why?

2. What specific physical examination findings would you look for and
why?

3. Based on given history and PE, what now is your primary working
impression? Give some basis.

4. Discuss the pathophysiology of your primary diagnosis and give

some possible complications.

5. What is your plan of management? (Diagnostics, medical and non-

medical/supportive)

6. What will you advise the patient and parents?

7. Cite at least 1 journal article related to your working impression.