Potential significance | |
Historical findings | |
Involuntary weight loss | Malabsorption (IBD, celiac disease, pancreatitis), malignancy |
Difficulty swallowing (dysphagia) or painful swallowing (odynophagia) | Eosinophilic esophagitis, pill esophagitis, infectious esophagitis, achalasia |
Significant vomiting (bilious, protracted, projectile, or otherwise worrisome) | Acid-peptic disease, cyclic vomiting syndrome, eosinophilic gastroenteritis, bowel obstruction, hepatobiliary disease, metabolic (eg, diabetic ketoacidosis, adrenal crisis), cholecystitis, intracranial lesion |
Chronic severe diarrhea (≥3 loose or watery stools per day for more than 2 weeks) or nocturnal diarrhea | Enteric infection (parasitic, bacterial, viral), IBD, immune deficiency, celiac disease, food protein-induced enteropathy |
Unexplained fever | Infectious or inflammatory process; familial Mediterranean fever |
Urinary symptoms (change in bladder function, dysuria, hematuria, flank pain) | Recurrent urinary tract infection; nephrolithiasis |
Back pain | Referred pain (eg, chronic pancreatitis) |
Family history of IBD, celiac disease, peptic ulcer disease | IBD, celiac disease, peptic ulcer disease |
Bloody diarrhea | IBD |
Melena (black, tarry stools) | Acid peptic disease |
Hematochezia | Meckel's diverticulum |
Skin changes (rash, eczema, hives) | IBD, celiac disease, food allergy |
Examination findings | |
Deceleration in linear growth (eg, height gain <5 cm/year in a prepubertal child) and/or delayed puberty | IBD, celiac disease |
Oral aphthous ulcerations | IBD |
Localized right upper quadrant tenderness | Hepatobiliary disease (eg, gallstones, cholecystitis, extrahepatic bile duct [choledochal cyst]) |
Localized right lower quadrant pain | Ovarian cyst or mass, chronic appendicitis |
Left lower quadrant pain | Constipation, ovarian cyst or mass, ulcerative colitis |
Suprapubic tenderness | Urinary tract infection |
Hepatomegaly | Chronic hepatitis, hepatobiliary disease, storage disease (eg, Gaucher disease) |
Splenomegaly | Hemolytic disease, splenic infarct, splenic abscess, storage disease |
Costovertebral angle tenderness | Pyelonephritis |
Perianal abnormalities (eg, skin tags, fissures, fistulae) | IBD |
Guaiac-positive stool | Enteric infection, IBD, juvenile polyps, acid-peptic disease, foreign body, vasculitis (eg, polyarteritis nodosa); proximal small bowel disease (Crohn disease, Helicobacter pylori, peptic disease, celiac disease) |
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