BRONX-LEBANON HOSPITAL CENTER

Debra Pan, M.D.

Primary Goals for this Rotation

Food Allergy

Understand the role of the general pediatrician in the assessment and management of patients with food allergy.

Identify the signs and symptoms of food allergy and differentiate food allergy from other causes of skin rash, GI, and pulmonary symptoms

Differentiate IgE-mediated food allergy from non-IgE mediated food allergy.

Prevention, Counseling and Screening

Understand the role of the pediatrician in preventing gastrointestinal disease or nutritional deficiencies, and in counseling and screening individuals at risk for these diseases.

Provide routine gastrointestinal preventive counseling to all parents and patients that addresses good nutrition, bowel training and dietary prevention of constipation, prevention of Hepatitis A and B through immunization and good hand washing and food preparation techniques for the prevention of gastrointestinal infections.

Provide gastroenterology counseling to parents and patients with specific GI conditions that addresses importance of compliance with medications for inflammatory bowel and liver disease, need for surgery in specific gastroenterology conditions, e.g. ulcerative colitis,Peutz Jaeger’s, etc.; need for specialized diets in certain gastroenterology conditions, e.g., IBD, celiac disease, failure to thrive, obesity, lactose intolerance, etc.; dealing with abdominal pain of apparent psychosomatic origin.

Normal Versus Abnormal

Differentiate between normal and pathological states related to gastroenterology.

Describe the normal eating patterns from birth through adolescence, including expected weight gain and typical feeding behaviors.

Describe normal developmental patterns in gastrointestinal development, including gastro-esophageal reflux, bowel habits, and stool color and consistency.

Vomiting

Diagnose and manage vomiting

Differentiate normal infant spitting up and functional asymptomatic gastroesophageal reflux from vomiting disorders requiring evaluation and treatment.

Describe both common and serious disorders leading to vomiting (both intestinal and extraintestinal) and the appropriate use of laboratory and imaging studies to aid in diagnosis.

Recognize symptoms and urgently refer children with vomiting caused by intestinal obstruction.

Describe the typical presentation and suspected course of viral gastroenteritis and evaluate vomiting that does not conform to this presentation and course.

Recognize signs and symptoms of dehydration in a child with vomiting. Calculate fluid deficits based on weight and clinical symptoms and manage rehydration using IV fluids or oral rehydration solutions.

Abdominal Pain

Diagnose and manage abdominal pain.

Compare the common causes of abdominal pain and describe signs and symptoms that differentiate recurrent (functional) abdominal pain of childhood from other organic causes that require further evaluation and treatment.

Explain the key components of a complete history and physical examination for abdominal pain. These should include pain patterns, weight loss, complete diet history, elimination history (including stool size, pattern, and consistency), psychosocial history, rectal exam and an age/gender dependent pelvic exam.

Diarrhea

Diagnose and manage diarrhea.

Compare and contrast the infectious and non-infectious causes of diarrhea. Describe signs and symptoms that differentiate self-limiting diarrhea from diarrhea requiring further evaluation and treatment.

Explain the key components of a complete history and physical examination for diarrhea, including a complete diet history, length of illness, elimination history (including stool size, pattern, and consistency), and travel history, in order to classify a diarrheal illness as acute or chronic.

Recognize signs and symptoms of dehydration in a child with diarrhea. Calculate fluid deficits based on weight and clinical symptoms and manage rehydration using IV fluids or oral rehydration solutions.

Recognize signs and symptoms of dehydration in a child with diarrhea. Calculate fluid deficits based on weight and clinical symptoms and manage rehydration using IV fluids or oral rehydration solutions.

Nutrition

Understand principles of nutrition important to the general pediatrician.

Conduct an age-appropriate nutritional history and exam for nutritional disorders.

List conditions that may present with malnutrition or which commonly occur in combination with malnutrition.

Cystic Fibrosis

Understand the general pediatrician's role in the management of cystic fibrosis.

Discuss the presenting signs and symptoms of cystic fibrosis and refer the patient for appropriate confirmatory testing, education, and treatment. Discussion should include high risk populations, associated symptoms, treatment options and expected course of the disease.

Participate in development and implementation of a coordinated pulmonary and nutritional treatment plan for a patient with cystic fibrosis, including recognition and treatment of acute episodic illnesses, nutritional deficiencies, intestinal obstruction, and psychosocial issues. Discuss the multidisciplinary approach to cystic fibrosis care and the role of the general pediatrician.