1. What you might or expect to see on a physical exam
For a child with chronic constipation, expected findings on physical exam would
be similar to that of the patient in the case this week. These would include
generalized discomfort, mild abdominal pain and potentially a palpable mass in the
lower left quadrant if they are experiencing fecal impaction (UpToDate, 2024).
Abdominal distention, significant pain with palpation, or abnormalities of the
thyroid exam would be concerning findings of potentially more critical conditions
(UpToDate, 2024).
2. A minimum of 3 differential diagnoses.
Three differential diagnoses for constipation in children may include
hypothyroidism, celiac disease, or Hirschsprung Disease (UpToDate, 2024). All of
these differentials should be taken into consideration when examining children
who present with constipation as constipation is a symptom of all of them and can
put the child at increased risk if left untreated.
3. Diagnostic tests/labs needed for each differential you chose.
Hypothyroidism diagnosis would be based off physical examination and a TSH
and Free T4 level (P. Allen et al., 2024). The presenting symptoms of constipation
in addition to exophthalmos, lid lag, and palpation of goiter would prompt lab tests
to specifically assess elevation of TSH and normal to slightly elevated T4 level to
confirm diagnosis. If Celiac Disease is suspected, serum IgA, IgG, tissue
transglutaminase (TTG) antibody lab tests would be ordered and possible referral
to endoscopy for a biopsy (P. Allen et al., 2024). In the case of Hirschsprung
Disease, if physical examination revealed abdominal distention and increased
rectal tone in addition to constipation, then an abdominal X-ray would be beneficial
This study source was downloaded by 100000901524459 from CourseHero.com on 10-06-2025 06:47:59 GMT -05:00
https://www.coursehero.com/file/248308869/Week-5-iHuman-Reflectiondocx/
For a child with chronic constipation, expected findings on physical exam would
be similar to that of the patient in the case this week. These would include
generalized discomfort, mild abdominal pain and potentially a palpable mass in the
lower left quadrant if they are experiencing fecal impaction (UpToDate, 2024).
Abdominal distention, significant pain with palpation, or abnormalities of the
thyroid exam would be concerning findings of potentially more critical conditions
(UpToDate, 2024).
2. A minimum of 3 differential diagnoses.
Three differential diagnoses for constipation in children may include
hypothyroidism, celiac disease, or Hirschsprung Disease (UpToDate, 2024). All of
these differentials should be taken into consideration when examining children
who present with constipation as constipation is a symptom of all of them and can
put the child at increased risk if left untreated.
3. Diagnostic tests/labs needed for each differential you chose.
Hypothyroidism diagnosis would be based off physical examination and a TSH
and Free T4 level (P. Allen et al., 2024). The presenting symptoms of constipation
in addition to exophthalmos, lid lag, and palpation of goiter would prompt lab tests
to specifically assess elevation of TSH and normal to slightly elevated T4 level to
confirm diagnosis. If Celiac Disease is suspected, serum IgA, IgG, tissue
transglutaminase (TTG) antibody lab tests would be ordered and possible referral
to endoscopy for a biopsy (P. Allen et al., 2024). In the case of Hirschsprung
Disease, if physical examination revealed abdominal distention and increased
rectal tone in addition to constipation, then an abdominal X-ray would be beneficial
This study source was downloaded by 100000901524459 from CourseHero.com on 10-06-2025 06:47:59 GMT -05:00
https://www.coursehero.com/file/248308869/Week-5-iHuman-Reflectiondocx/
