ROSH Gastrointestinal Practice Exam

In the context of a teenager presenting with abdominal pain, which symptom is a red flag for serious pathology?

1. Intolerance to feeding

2. Symptoms improving with analgesics

3. Intermittent pain

4. History of previous similar episodes

The correct answer is: Intolerance to feeding

Intolerance to feeding in a teenager presenting with abdominal pain may indicate serious underlying conditions, such as gastrointestinal obstructions, infections (like appendicitis or pancreatitis), or even metabolic issues. When a patient is unable to tolerate food, it signals that something may be significantly amiss with their digestive system, possibly suggesting an acute problem that warrants further investigation. Other symptoms mentioned, such as pain improving with analgesics or intermittent pain, may be more characteristic of less severe, chronic conditions or functional abdominal pain that is common in this age group. Similarly, a history of previous similar episodes could indicate a recurrent or chronic issue, but not necessarily an acute or serious pathology. Therefore, intolerance to feeding stands out as a strong indicator that further evaluation is needed to rule out critical gastrointestinal conditions.