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Pediatric Diagnostic Labs for Primary Care: An Evidence-based Approach pp 319–363Cite as

Care of the Child with a Gastrointestinal Disorder

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Abstract

The child who presents with a possible gastrointestinal disorder needs a complete history and physical and a careful diagnostic plan when ordering diagnostic laboratory tests. The sensitivity, specificity, positive and negative likelihood ratios, and pretest probability of your working diagnosis help the clinician decide what diagnostic laboratory tests to order. Diagnostic stewardship asks the clinicians to order tests based on a careful history and physical. The child with jaundice may require specialty care, but an initial workup in primary care helps the specialist decide on the situation’s urgency. For example, a newborn with prolonged jaundice and elevated direct bilirubin needs an urgent appointment. In contrast, the well-appearing child with a negative history and physical whose mother insists on a specialist may be able to wait for an appointment. Primary care clinicians must exercise good judgment in evaluating the child with a GI complaint when ordering diagnostic lab tests to avoid false-positive results and further confuse the diagnosis.

Keywords

  • Stool for ova and parasites
  • Diarrhea
  • Inflammatory bowel disease
  • Celiac disease
  • Total IgA
  • Tissue transglutaminase IgA
  • Deamidated gliadin peptide (DGP) IgA and IgG
  • Endomysial IgA
  • Fecal calprotectin
  • Liver enzymes
  • Autoimmune liver disease
  • Jaundice
  • Gamma-glutamyl transferase

Anna L. Rundle: Special Thanks to Dr. Steven Lobritto

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Authors and Affiliations

  1. Pediatric Center for Liver Disease and Transplantation, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA

    Anna L. Rundle

  2. Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA

    Nicole Baron

  3. School of Nursing, Columbia University, New York, NY, USA

    Rita Marie John

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    Rita Marie John

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Rundle, A.L., Baron, N., John, R.M. (2022). Care of the Child with a Gastrointestinal Disorder. In: John, R.M. (eds) Pediatric Diagnostic Labs for Primary Care: An Evidence-based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-90642-9_9

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