A 5-year-old has a history of chronic recurrent abdominal pain and emesis. A diagnosis of cyclic vomiting was made at 3 years of age. Therapy with antimigraine medications was unsuccessful. During each episode, the serum ammonia, pH, glucose, and bicarbonate were normal. He now manifests bile-stained emesis, a tender distended abdomen, and bright-red blood per rectum. The most likely diagnosis is

Correct Answer: D

Rationale: The most likely diagnosis in this case is superior mesenteric artery syndrome (D). Superior mesenteric artery syndrome, also known as Wilkie's syndrome, occurs due to compression of the third part of the duodenum between the abdominal aorta and the overlying superior mesenteric artery. This compression leads to obstruction of the duodenum, causing symptoms like vomiting, abdominal pain, and potentially gastrointestinal bleeding. The presentation of bile-stained emesis, a tender distended abdomen, and bright-red blood per rectum points towards this diagnosis. Option A, stress ulcers, is unlikely because the symptoms described do not align with stress-related gastrointestinal issues. Intussusception (B) typically presents with colicky abdominal pain and a sausage-shaped mass on palpation, which are not noted in this case. Malrotation (C) usually presents earlier in infancy and is associated with bilious vomiting and a "corkscrew" appearance on imaging, making it less likely in a 5-year-old with this presentation. Educationally, understanding the clinical manifestations and diagnostic approach to gastrointestinal conditions in children is crucial for healthcare providers, especially those preparing for exams like the NCLEX. This question highlights the importance of recognizing rare but critical conditions like superior mesenteric artery syndrome based on specific clinical clues to ensure timely and accurate management.

Correct Answer: B

Rationale: The correct answer is B) celiac disease. Celiac disease is a gastrointestinal disorder triggered by the ingestion of gluten-containing foods. In this scenario, the child's symptoms of failure to thrive, poor appetite, abdominal distention, diarrhea, and irritability are indicative of celiac disease. The onset of symptoms around 9 months of age is common as gluten-containing foods are introduced into the diet around that time. Option A) giardiasis is unlikely as it typically presents with foul-smelling, greasy stools and is more common in areas with poor sanitation. Option C) cystic fibrosis may present with similar symptoms but typically also involves respiratory issues which are not described in the question. Option D) mitochondrial myopathy would not typically present with gastrointestinal symptoms like diarrhea and poor appetite. In an educational context, understanding the presentation of pediatric gastrointestinal disorders is crucial for nurses, especially when caring for infants and young children. Recognizing the signs and symptoms of celiac disease can lead to early diagnosis and intervention, which is essential for preventing long-term complications and promoting the child's growth and development. Nurses must be able to differentiate between various pediatric gastrointestinal conditions to provide optimal care and support to their patients and families.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) chronic fatigue syndrome. 1. Chronic fatigue syndrome: This condition is characterized by extreme fatigue that cannot be explained by any underlying medical condition. While fatigue is a symptom shared with the patient's presentation, the presence of jaundice and other symptoms points more towards a hepatobiliary condition rather than chronic fatigue syndrome. 2. Mononucleosis: Mononucleosis can present with symptoms such as malaise, fatigue, anorexia, and jaundice, which overlap with the patient's symptoms. However, considering the patient's demographic and the presence of jaundice, other hepatobiliary conditions are more likely. 3. Chronic active hepatitis: Given the patient's symptoms of jaundice and liver involvement, chronic active hepatitis is a pertinent consideration in the differential diagnosis. 4. Hepatitis B: Hepatitis B is a viral infection that affects the liver and can present with symptoms like jaundice, fatigue, and anorexia, making it relevant to consider in this case. Educational context: Understanding the differential diagnosis in a pediatric patient presenting with symptoms like malaise, fatigue, anorexia, and jaundice is crucial for healthcare providers. This question challenges critical thinking by assessing the ability to differentiate between conditions with overlapping symptoms. By recognizing the specific features of each condition, healthcare professionals can provide accurate diagnosis and appropriate management for pediatric patients with gastrointestinal issues.

Correct Answer: A

Rationale: In this question, the correct answer is A) Hirschsprung disease. Hirschsprung disease is a congenital condition where there is a lack of ganglion cells in the colon, leading to chronic constipation. This condition is commonly seen in pediatric patients and can present with symptoms of constipation, abdominal distention, and failure to pass meconium. Option B) Functional constipation is a common cause of constipation in children and is usually due to dietary factors, lack of fluids, or behavioral issues. It is not typically associated with congenital abnormalities like Hirschsprung disease. Option C) an abscessed tooth is unrelated to constipation. Dental issues can cause pain and discomfort in the mouth but do not directly lead to constipation. Option D) angioedema is a condition characterized by rapid swelling of the deep layers of skin. It is not associated with constipation. Educational context: Understanding the different causes of constipation in pediatric patients is crucial for nurses and healthcare providers. Recognizing the signs and symptoms of conditions like Hirschsprung disease can lead to early diagnosis and appropriate intervention. This knowledge is essential for providing safe and effective care to pediatric patients with gastrointestinal issues.

Correct Answer: A

Rationale: In the context of pediatric gastrointestinal health, understanding the causes of vomiting is crucial for accurate assessment and intervention. In this question, the correct answer is A) atrial septal defect. An atrial septal defect is a congenital heart condition that affects the heart's structure, leading to abnormal blood flow between the atria. While it can cause symptoms like fatigue and shortness of breath, vomiting is not a typical manifestation of this cardiac defect. Option B) migraine is a common cause of vomiting in children, often accompanied by headache and sensitivity to light and sound. Migraines are a neurological disorder that can trigger gastrointestinal symptoms like nausea and vomiting. Option C) pregnancy is obviously not applicable in a pediatric context and can be ruled out as a cause of vomiting in children. Option D) labyrinthitis is an inner ear disorder that can lead to vertigo, nausea, and vomiting due to disturbances in the vestibular system. It is a possible cause of vomiting in children, especially if associated with dizziness or balance issues. Educationally, this question highlights the importance of recognizing both gastrointestinal and non-digestive causes of vomiting in pediatric patients. It underscores the need for a comprehensive assessment that considers various systemic conditions beyond the gastrointestinal tract. This knowledge is vital for nurses and healthcare providers working with pediatric populations to ensure accurate diagnosis and appropriate management of vomiting in children.