Version 1 and 2
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Max kings i- human case study cc; leaking stool
z z z z z z z z
Content; HPI STATEMENT, HISTORY, PHYSICAL EXAM, TESTING, DIFFERENTIAL DIAGNOSIS, SUMMA
z z z z z z z z z
RY, PLAN FOR PATIENT , EXERCISES, EXPERT FEEDBACK,CASE SUMMARY
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,Version 1 and 2
z z z
Max kings i- human case study cc; leaking stool
z z z z z z z z
HPI
Max King is a 4- z z z z
years Old Caucasian male child visited the clinic with his father with a complaint of leaking stools in
z z z z z z z z z z z z z z z z z z
his underwear for the past 3-
z z z z z
weeks. Father states that his child had intermittent abdominal pain for 2 years and had experienced ha
z z z z z z z z z z z z z z z z
rd stools as well. He also reported that his child started having watering stools, 2-
z z z z z z z z z z z z z z
3 times in a day for the past 3-
z z z z z z z z
weeks. He went further to explained that the abdominal pain usually starts after eating and gets better
z z z z z z z z z z z z z z z z
a few minutes.
z z z
According to max’s father, he states that his son is picky eater, and do not eat vegetables or healthy.
z z z z z z z z z z z z z z z z z z z
Max is known to love eating fried food and dessert, drink three cups of milks in a day, and do not drin
z z z z z z z z z z z z z z z z z z z z z
k enough water.
z z
The father mentioned that max is potty trained, and he denies nausea or vomiting, fever, bleeding wit
z z z z z z z z z z z z z z z z
h defecation, and headache. He reported of straining when defecating.
z z z z z z z z z
Physical examination revealed a diffuse tenderness to palpation of the abdomen.
z z z z z z z z z z
Treatment/Management Plan z
Primary Diagnosis: Encopresis and ICD-10 code: F98.1
z z z z z z
• Encopresis sometimes called stool soiling can been defined as an intentional or involuntary
z z z z z z z z z z z z z
movement of stools into the underwear or clothing. It usually occurs in toilet trained childre
z z z z z z z z z z z z z z
n with developmental age that is greater or equals to 4 years. The child usual resist defecatio
z z z z z z z z z z z z z z z z
n which causes feces to be impacted in the colon leading to constipation, and later followed
z z z z z z z z z z z z z z z z
by leaking watery stool (Colombo et al., 2017).
z z z z z z z
In most cases, it happens because a child has a chronic constipation. Some of the symptoms i
z z z z z z z z z z z z z z z z
nclude the need to have a bowel movement with little or no warning, lose or watery stool, lea
z z z z z z z z z z z z z z z z z
kage of stool into the underwear, intermittent abdominal pain, constipation, avoiding defec
z z z z z z z z z z z
ation, and urinary tract infections.z z z z
In this case Max has all the symptoms of encopresis, and both the subjective and objective d
z z z z z z z z z z z z z z z z
ata supported the diagnosis with the abdominal x-
z z z z z z z
ray that showed impacted large stools in the colon.
z z z z z z z z
Differential Diagnosis z
• Celiac disease – z z
K90.0: This is a genetic autoimmune reaction to eating gluten, a proteinfound in wheat, ba
z z z z z z z z z z z z z z z
rley, and rye, which can affect the gut, and other organsz z z z z z z z z z
,Version 1 and 2
z z z
(Wolters Kluwer Health., 2016). Some of the symptoms includes diarrhea, constipation, na
z z z z z z z z z z z
usea, vomiting, and weight loss. Max had diarrhea, constipation but there is no report of we
z z z z z z z z z z z z z z z
ightloss, nausea, vomiting, or eating any food that has gluten. The text did to rule
z z z z z z z z z z z z z z
, Version 1 and 2
z z z
out, were negative for celiac disease. So, celiac disease is not the primary diagnosis.
z z z z z z z z z z z z z
• Hypothyroidism-
E03.9: This is a condition whereby the thyroid gland do not produce enough of thyroid hor
z z z z z z z z z z z z z z z z
mones. Some of the symptoms are fatigue, constipation, and dry skin. Though, max has had
z z z z z z z z z z z z z z
constipation, but never complain of fatigue or skin dryness, and thyroid function test where
z z z z z z z z z z z z z z
negative. So, we rule out hypothyroidism as the primary.
z z z z z z z z z
• Constipation-
zK59.00: dissatisfying excretion of feces mark by infrequent stools, difficult stool passage o
z z z z z z z z z z z z
r both. Some of the characteristics include less three bowel movements a week, hard stools,
z z z z z z z z z z z z z z z
excessive straining, prolonged time spent on the toilet, a
z z z z z z z z
sense of incomplete evacuation, hard or small stools, difficulty passing feces, and abdomina
z z z z z z z z z z z z
l discomfort, such as pain, and bloating. This seems to be the diagnosis but based on the subj
z z z z z z z z z z z z z z z z z
ect and objective information gathered constipation only do not soil pants and underwear. T
z z z z z z z z z z z z z
his should be a supporting diagnosis.
z z z z z
Additional Laboratory and diagnostic tests:
z z z z
• UA/Urine culture to check for UTI/glucosuria. z z z z z
• Thyroid function tests: hypothyroidism z z z
• Abdominal x- z
ray to check for stool impaction: Result showing a large amount of stool filling the rectum
z z z z z z z z z z z z z z z
and sigmoid colon.
z z z
• Antigliadin antibodies (IgA, IgE, IgG): Use to diagnosed celiac disease.
z z z z z z z z z
• Electrolyte panel including calcium to check for hypokalemia, hypercalcemia, or h
z z z z z z z z z z
yperglycemia.
Consults/Referrals.
• Nutritionist for dietary management. z z z
• Counseling, and behavioral therapy may be considered due to parents’ divorce which may be
z z z z z z z z z z z z z z
a contributing factor.
z z
Therapeutic Modalities z
Pharmacological management/treatment: z
• Dis-
impaction with polyethylene glycol. 1.5g/kg/day, orally, daily for 3 days, and mainte
z z z z z z z z z z z
nance dose of 0.8g/kg/day orally, daily, for six months.
z z z z z z z z
Non-Pharmacological management: z
• Dietary changes by eating enough vegetables, eating healthier and drinking adequate w
z z z z z z z z z z z
ater until he sets up his regular bowel movement.
z z z z z z z z
• Continuation of toilet training until the successful maintenance of a regular bowel m
z z z z z z z z z z z z
ovement.
• Eating high fiber diet, fresh fruits, and fluid intake of 2000 to 3000ml/day if not con
z z z z z z z z z z z z z z z
traindicated.
• Being physical active
z z
Health Promotion:
z
• Early childhood is a time the parents should start to set up healthful eating patterns for the chil
z z z z z z z z z z z z z z z z z
z z z
Max kings i- human case study cc; leaking stool
z z z z z z z z
Content; HPI STATEMENT, HISTORY, PHYSICAL EXAM, TESTING, DIFFERENTIAL DIAGNOSIS, SUMMA
z z z z z z z z z
RY, PLAN FOR PATIENT , EXERCISES, EXPERT FEEDBACK,CASE SUMMARY
z z z z z z z z
,Version 1 and 2
z z z
Max kings i- human case study cc; leaking stool
z z z z z z z z
HPI
Max King is a 4- z z z z
years Old Caucasian male child visited the clinic with his father with a complaint of leaking stools in
z z z z z z z z z z z z z z z z z z
his underwear for the past 3-
z z z z z
weeks. Father states that his child had intermittent abdominal pain for 2 years and had experienced ha
z z z z z z z z z z z z z z z z
rd stools as well. He also reported that his child started having watering stools, 2-
z z z z z z z z z z z z z z
3 times in a day for the past 3-
z z z z z z z z
weeks. He went further to explained that the abdominal pain usually starts after eating and gets better
z z z z z z z z z z z z z z z z
a few minutes.
z z z
According to max’s father, he states that his son is picky eater, and do not eat vegetables or healthy.
z z z z z z z z z z z z z z z z z z z
Max is known to love eating fried food and dessert, drink three cups of milks in a day, and do not drin
z z z z z z z z z z z z z z z z z z z z z
k enough water.
z z
The father mentioned that max is potty trained, and he denies nausea or vomiting, fever, bleeding wit
z z z z z z z z z z z z z z z z
h defecation, and headache. He reported of straining when defecating.
z z z z z z z z z
Physical examination revealed a diffuse tenderness to palpation of the abdomen.
z z z z z z z z z z
Treatment/Management Plan z
Primary Diagnosis: Encopresis and ICD-10 code: F98.1
z z z z z z
• Encopresis sometimes called stool soiling can been defined as an intentional or involuntary
z z z z z z z z z z z z z
movement of stools into the underwear or clothing. It usually occurs in toilet trained childre
z z z z z z z z z z z z z z
n with developmental age that is greater or equals to 4 years. The child usual resist defecatio
z z z z z z z z z z z z z z z z
n which causes feces to be impacted in the colon leading to constipation, and later followed
z z z z z z z z z z z z z z z z
by leaking watery stool (Colombo et al., 2017).
z z z z z z z
In most cases, it happens because a child has a chronic constipation. Some of the symptoms i
z z z z z z z z z z z z z z z z
nclude the need to have a bowel movement with little or no warning, lose or watery stool, lea
z z z z z z z z z z z z z z z z z
kage of stool into the underwear, intermittent abdominal pain, constipation, avoiding defec
z z z z z z z z z z z
ation, and urinary tract infections.z z z z
In this case Max has all the symptoms of encopresis, and both the subjective and objective d
z z z z z z z z z z z z z z z z
ata supported the diagnosis with the abdominal x-
z z z z z z z
ray that showed impacted large stools in the colon.
z z z z z z z z
Differential Diagnosis z
• Celiac disease – z z
K90.0: This is a genetic autoimmune reaction to eating gluten, a proteinfound in wheat, ba
z z z z z z z z z z z z z z z
rley, and rye, which can affect the gut, and other organsz z z z z z z z z z
,Version 1 and 2
z z z
(Wolters Kluwer Health., 2016). Some of the symptoms includes diarrhea, constipation, na
z z z z z z z z z z z
usea, vomiting, and weight loss. Max had diarrhea, constipation but there is no report of we
z z z z z z z z z z z z z z z
ightloss, nausea, vomiting, or eating any food that has gluten. The text did to rule
z z z z z z z z z z z z z z
, Version 1 and 2
z z z
out, were negative for celiac disease. So, celiac disease is not the primary diagnosis.
z z z z z z z z z z z z z
• Hypothyroidism-
E03.9: This is a condition whereby the thyroid gland do not produce enough of thyroid hor
z z z z z z z z z z z z z z z z
mones. Some of the symptoms are fatigue, constipation, and dry skin. Though, max has had
z z z z z z z z z z z z z z
constipation, but never complain of fatigue or skin dryness, and thyroid function test where
z z z z z z z z z z z z z z
negative. So, we rule out hypothyroidism as the primary.
z z z z z z z z z
• Constipation-
zK59.00: dissatisfying excretion of feces mark by infrequent stools, difficult stool passage o
z z z z z z z z z z z z
r both. Some of the characteristics include less three bowel movements a week, hard stools,
z z z z z z z z z z z z z z z
excessive straining, prolonged time spent on the toilet, a
z z z z z z z z
sense of incomplete evacuation, hard or small stools, difficulty passing feces, and abdomina
z z z z z z z z z z z z
l discomfort, such as pain, and bloating. This seems to be the diagnosis but based on the subj
z z z z z z z z z z z z z z z z z
ect and objective information gathered constipation only do not soil pants and underwear. T
z z z z z z z z z z z z z
his should be a supporting diagnosis.
z z z z z
Additional Laboratory and diagnostic tests:
z z z z
• UA/Urine culture to check for UTI/glucosuria. z z z z z
• Thyroid function tests: hypothyroidism z z z
• Abdominal x- z
ray to check for stool impaction: Result showing a large amount of stool filling the rectum
z z z z z z z z z z z z z z z
and sigmoid colon.
z z z
• Antigliadin antibodies (IgA, IgE, IgG): Use to diagnosed celiac disease.
z z z z z z z z z
• Electrolyte panel including calcium to check for hypokalemia, hypercalcemia, or h
z z z z z z z z z z
yperglycemia.
Consults/Referrals.
• Nutritionist for dietary management. z z z
• Counseling, and behavioral therapy may be considered due to parents’ divorce which may be
z z z z z z z z z z z z z z
a contributing factor.
z z
Therapeutic Modalities z
Pharmacological management/treatment: z
• Dis-
impaction with polyethylene glycol. 1.5g/kg/day, orally, daily for 3 days, and mainte
z z z z z z z z z z z
nance dose of 0.8g/kg/day orally, daily, for six months.
z z z z z z z z
Non-Pharmacological management: z
• Dietary changes by eating enough vegetables, eating healthier and drinking adequate w
z z z z z z z z z z z
ater until he sets up his regular bowel movement.
z z z z z z z z
• Continuation of toilet training until the successful maintenance of a regular bowel m
z z z z z z z z z z z z
ovement.
• Eating high fiber diet, fresh fruits, and fluid intake of 2000 to 3000ml/day if not con
z z z z z z z z z z z z z z z
traindicated.
• Being physical active
z z
Health Promotion:
z
• Early childhood is a time the parents should start to set up healthful eating patterns for the chil
z z z z z z z z z z z z z z z z z
