Colic

Chapter 99 Colic




Clinical Case Problem 1: “Make her stop crying!”


A distressed mother sees you for the first time and states that her 5-week-old daughter has been crying nonstop for 2   weeks. Her husband states that he is leaving for a business trip. The father notes that their son had to have a “stomach operation” in the fifth week of life “for vomiting and pain.” The baby cries for 3 or 4 hours continuously, mainly in the afternoons, clenching her fists and pulling her legs toward the abdomen. The child is not suffering from diarrhea, and she passes flatus when she cries. You note an adequate weight gain on the growth chart.



Select the best answer to the following questions




1. In this case, you will


a. perform the minimum necessary laboratory tests: a complete blood count (CBC), urinalysis, and chest radiograph

b. reassure the mother of the benign nature of the problem

c. obtain a computed tomography scan of the abdomen

d. order an ultrasound study to rule out pyloric stenosis

e. perform a thorough history and physical examination

2. After a complete history and physical examination, what is the first laboratory test you should undertake?


a. CBC

b. erythrocyte sedimentation rate (ESR) and CBC with complete white count

c. chest radiograph followed by tympanometry

d. urinalysis

e. chemistry panel, CBC, and ESR

3. To establish the diagnosis of colic, you will use


a. history and physical examination and the necessary laboratory workup

b. the Wessel criteria (i.e., the rule of 3’s)

c. the Wessel criteria after organic reasons for crying have been ruled out

d. “test for a cure” by changing from cow’s milk to a hypoallergenic formula and reassessing in 7   days

e. treatment with dicyclomine (Bentyl) for 1   week to decrease abdominal spasms

4. You diagnose the child with infantile colic. A known cause of infantile colic is


a. increase in feeding frequency or underfeeding

b. allergy to cow’s milk formula (food protein–induced enterocolitis syndrome)

c. parental stress level as well as the number of siblings at home

d. premature delivery or intrauterine growth slowing

e. there are no established causes of infantile colic

5. Infantile colic is described as


a. unprovoked, unrelieved crying, starting in the afternoon hours and accompanied by the child’s having clenched fists and pulling its legs toward the abdomen

b. unpredictable crying occurring 24 hours a day and usually increasing with maternal fatigue

c. more common in infants who are breast-fed

d. always a herald of psychological disorders in childhood

e. easily relieved by promethazine (Phenergan) and dicyclomine (Bentyl)

The parents are exhausted and frustrated, and they ask what they can do to restore some quiet to their home. You review further history to make intervention recommendations.



6. A contributing factor in infantile colic is


a. maternal smoking

b. parental stress levels and marital status

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Colic

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