| Sign or symptom | Potential implications |
| Fever | |
| Gross blood in stool | - Colonic inflammation (eg, infection, IBD, or vasculitis)
- For differential diagnosis, refer to UpToDate content on lower and upper GI bleeding
|
| Weight loss or faltering (as shown on weight curve or change in weight Z-score) | - Dehydration (acute)
- Malabsorption
- Systemic or inflammatory disorder
|
| Decreased height velocity (as shown on length/height curve or change in Z-score) | - Chronically insufficient caloric intake/absorption
- Chronic systemic or inflammatory disorder (eg, IBD)
|
| Nausea or vomiting | - Systemic disease
- Organic GI disorder (dysmotility, obstruction, inflammation)
|
| Chronic candidiasis or severe eczematoid rash | - Possible immunodeficiency (common manifestation)
|
| Skin or joint manifestations suggesting systemic disease | - Depending on rash, consider:
- Allergy
- Celiac disease
- IBD
- Mastocytosis
|
| Abdominal and perianal examination |
- Severe abdominal distension
| - Partial bowel obstruction
- Excessive gas due to carbohydrate fermentation, which may be caused by:
|
| | - Liver disease with portal hypertension
- Protein-losing enteropathy
|
- Jaundice, hepatosplenomegaly, or mass
| - Systemic disorder (eg, CVID)
- Inflammatory disorder
- Tumor (eg, VIPoma)
|
| | - Inflamed organs or peritoneum (peritonitis), eg, due to IBD
|
- Perirectal fissure, fistula, or abscess
| |
| Electrolyte and/or renal abnormalities | - Chronic electrolyte and fluid loss due to diarrhea
|
