Version June 2024
| Potential significance | |
| Historical findings | |
| Involuntary weight loss | Malabsorption (IBD, celiac disease, pancreatitis), malignancy |
| Difficulty swallowing (dysphagia) or painful swallowing (odynophagia) | Eosinophilic esophagitis, pill esophagitis, infectious esophagitis, achalasia |
| Significant vomiting (bilious, protracted, projectile, or otherwise worrisome) | Acid-peptic disease, cyclic vomiting syndrome, eosinophilic gastroenteritis, bowel obstruction, hepatobiliary disease, metabolic (eg, DKA, adrenal crisis), cholecystitis, intracranial lesion |
| Chronic severe diarrhea (≥3 loose or watery stools per day for more than 2 weeks) or nocturnal diarrhea | Enteric infection (parasitic, bacterial, viral), IBD, immune deficiency, celiac disease, food protein-induced enteropathy |
| Unexplained fever | Infectious or inflammatory process; familial Mediterranean fever |
| Urinary symptoms (change in bladder function, dysuria, hematuria, flank pain) | Recurrent urinary tract infection; nephrolithiasis |
| Back pain | Referred pain (eg, chronic pancreatitis) |
| Family history of IBD, celiac disease, peptic ulcer disease | IBD, celiac disease, peptic ulcer disease |
| Bloody diarrhea | IBD |
| Melena (black, tarry stools) | Acid peptic disease, Meckel diverticulum |
| Skin changes (rash, eczema, hives) | IBD, celiac disease, food allergy |
| Examination findings | |
| Deceleration in linear growth (eg, height gain <5 cm/year in a prepubertal child) and/or delayed puberty | IBD, celiac disease |
| Oral aphthous ulcerations | IBD |
| Localized right upper quadrant tenderness | Hepatobiliary disease (eg, gallstones, cholecystitis, extrahepatic bile duct [choledochal cyst]) |
| Localized right lower quadrant pain | Ovarian cyst or mass, chronic appendicitis |
| Left lower quadrant pain | Constipation, ovarian cyst or mass, ulcerative colitis |
| Suprapubic tenderness | Urinary tract infection |
| Hepatomegaly | Chronic hepatitis, hepatobiliary disease, storage disease (eg, Gaucher disease) |
| Splenomegaly | Hemolytic disease, splenic infarct, splenic abscess, storage disease |
| Costovertebral angle tenderness | Pyelonephritis |
| Perianal abnormalities (eg, skin tags, fissures, fistulae) | IBD |
| Guaiac-positive stool | Enteric infection, IBD, juvenile polyps, acid-peptic disease, foreign body, vasculitis (eg, polyarteritis nodosa); proximal small bowel disease (Crohn disease, Helicobacter pylori, peptic disease, celiac disease) |
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