Gastrointestinal physiology

Presentation: History and physical examination

D.L. has had multiple visits and inpatient hospitalizations during her life for GI-related complaints. When she was an infant she was had been hospitalized twice for intussusception and underwent surgery. She has always been a small girl but recently she has fallen off her growth curve and is now less then fifth percentile for height and weight. Her mother tells you that D.L. has frequent loose watery stools and complains of abdominal pain frequently. They have tried a number of new dieting strategies, including staying away from rich foods and decreasing dairy products, but this has not helped. D.L. seems fatigued during the visit and she reports not feeling like participating in her usual summer activities or even riding her bike with her friends. She has not traveled at all this summer.

On physical examination D.L. is sitting comfortably on the examination table. She is alert but fatigued, however she can answer questions without difficulty. Her neurologic and cardiovascular examinations are in unremarkable. Her respiratory examination is clear to auscultation and percussion. Her abdominal examination demonstrates diffuse tenderness without peritoneal signs or distention. She has pruritic papules on her knees and buttocks that her mother states have been there for a few weeks. There are two large areas of ecchymosis on her right arm and one on her shin.