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Clinical utility of various diagnostic studies in the diagnosis of vomiting in a child

Clinical utility of various diagnostic studies in the diagnosis of vomiting in a child
Name of study Utility
Complete blood count Anemia and iron deficiency may be associated with obstruction, IBD, gastritis, and ulcer disease.
Elevated white blood cell count is associated with bacterial infections, appendicitis, and sepsis.
Electrolytes, BUN, creatinine Electrolyte abnormalities are associated with pyloric stenosis, adrenal insufficiency, and metabolic diseases.
Elevated BUN and creatinine are seen in kidney disease.
Hepatic aminotransferases Elevated AST, ALT, total bilirubin, and GGTP are seen in liver and gallbladder disease.
Amylase, lipase Elevated in pancreatitis.
Plasma ammonia, urine-reducing substances If an inborn error of metabolism is suspected. Ammonia is elevated in urea cycle disorders and organic acidemias. Non-glucose-reducing substances are usually present in the urine in galactosemia or hereditary fructose intolerance.
Plain radiograph of the abdomen If intestinal obstruction is suspected.
Upper gastrointestinal series If an anatomic abnormality of the upper gastrointestinal tract is suspected (eg, neonate with bilious vomiting).
CT of the head If increased intracranial pressure is suspected (rule out mass).
Abdominal ultrasound If pyloric stenosis or intussusception are suspected; also useful for evaluation of liver, gallbladder, kidneys, and pancreas.
Radionucleotide gastric emptying study If gastroparesis is suspected.
Endoscopy If peptic disease, eosinophilic esophagitis, IBD, or other causes of intestinal inflammation are suspected.
IBD: inflammatory bowel disease; BUN: blood urea nitrogen; AST: aspartate aminotransferase; ALT: alanine aminotransferase; GGTP: gamma-glutamyl transpeptidase; CT: computed tomography.
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