Pediatric EM
Just another case of vomiting? By Dr Subramaniam
A 14 year old boy is brought in by his mother on Saturday at 9.00am because he woke her up at 6.00am vomiting clear liquid and complaining of lower abdominal pain. You start taking the history from the young man, but he seems uncomfortable with pain and prefers his mother speak to you. You order some ibuprofen while talking to the mother. She says he’s been well with no fevers. She says he has not been traveling, has been having regular home cooked meals and has been voiding without pain and stooling regularly with no change in bowel movements.
He has no medical or surgical history, not on any medication, is fully immunized and was fine yesterday. No one at home has this problem and all his regular school friends have been fine according to the boy.
You examine his HEENT, heart, lungs and abdomen and are surprised with how benign the exam actually is. Rovsings and are Obturator negative, and he tolerates the mashing of your hand on his belly and costovetebral angles. His skin is well perfused and he has a normal neurological and MSK exam.
1. What has the resident forgot to examine in this male child with lower abdominal pain?
2. The attending completes the exam and beckons you over to look at his finding. Click the answer below to see what the attending discovers.
