Question

A 10 year old girl presents with several months of diarrhea and flatulence. Her parents report that despite the fact that she has been eating well, she has had a small weight loss during this period. She denies blood in her stool, but does report that her stools have been quite foul smelling and greasy. Physical examination reveals a pale, thin girl with blonde hair and blue eyes. Bowel sounds are slightly hyperactive, and there is no tenderness to palpation. Lungs sounds are normal. There is an erythematous, papulo-vesicular rash with signs of excoriation bilaterally at the knees and elbows. Laboratory evaluation shows serum anti-tissue transglutaminase (anti-TTG) antibodies are elevated. Which of the following is the most appropriate next step in the management of this patient?

A. Loperamide
B. Dietary avoidance of wheat, barley and oats
C. Chloride sweat test
D. Rectal biopsy
E. Amoxicillin

Answer 1

The most appropriate next step in the management of this patient is dietary avoidance of wheat, barley, and oats. The clinical presentation and laboratory evaluation suggest celiac disease, which is an autoimmune disorder triggered by gluten consumption. The gold standard for diagnosis is endoscopy and biopsy, but serological tests can be used as screening tools.

Step-by-step explanation:

The most appropriate next step in the management of this patient is B. Dietary avoidance of wheat, barley and oats. The clinical presentation, including chronic diarrhea, foul-smelling and greasy stools, and weight loss, along with the presence of elevated serum anti-tissue transglutaminase (anti-TTG) antibodies, suggests celiac disease. Celiac disease is an autoimmune disorder triggered by the consumption of gluten. The gold standard for diagnosis is endoscopy and biopsy of the duodenal mucosa, but serological tests can be used as screening tools. The most effective treatment for celiac disease is strict adherence to a gluten-free diet.