History |
Abdominal pain, appetite |
Stool frequency, consistency, rectal bleeding, nocturnal diarrhea |
Family history – Relatives with IBD, familial growth patterns |
Previous growth data* |
School attendance and daily activity |
Psychosocial history, including impact upon daily life of patient and parent(s) |
Physical examination |
Height and weight, evaluating for trends and growth velocity* |
Abdominal examination – Tenderness, mass |
Rectal examination – Evaluate for perianal disease and occult blood |
Rash, arthritis, clubbing, oral lesions |
Sexual maturity staging (Tanner stage)* |
Laboratory tests |
CBC with differential count, platelets, ESR, CRP |
Serum total protein, albumin |
ALT, AST, GGTP (to assess for hepatobiliary disease, including primary sclerosing cholangitis) |
Stool for occult blood and calprotectin or lactoferrin; urine analysis |
Stool bacterial culture, ova and parasite testing, C. difficile testing |
Tuberculosis screening (interferon-gamma testing or tuberculin skin test)Δ |
Titers for varicella and measles; HBV serologiesΔ |
Additional tests as indicated, depending upon clinical findings: - To further characterize the type of inflammatory bowel disease – P-ANCA, ASCA◊
- To investigate other causes of diarrhea – Lactose/glucose hydrogen breath test for lactose intolerance/bacterial overgrowth, 72-hour fecal fat quantitation, and stool alpha-1 antitrypsin
- If poor nutrition is suspected – Serum iron; calcium; magnesium; folate; vitamins A, E, and B12; and zinc*
|
Imaging |
For localization of small bowel disease, 1 of the following§: - MRE
- UGI/SBFT
- Abdominal CT with oral contrast
|
Additional tests as indicated, depending upon clinical findings – Bone age*, abdominal plain films, fistulogram or ultrasound |
Endoscopy |
Colonoscopy (including ileoscopy) with biopsies |
Upper endoscopy with biopsies |
Additional procedures as indicated: - Video capsule endoscopy if more information on small bowel involvement is needed
- MRCP or ERCP if sclerosing cholangitis is suspected
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