USMLE Forum Archives - USMLE Step 3 - abdominal pain and constant crying
abdominal pain and constant crying
zkadhem - 07-24-09 09:42
A 19-month-old Caucasian boy is brought to the emergency department. According to his mother, he has been constantly crying, and this is apparently due to intermittent abdominal pain. From time to time, he draws up his legs and pulls them towards his abdomen. His symptoms began ten hours ago. He has vomited at least four times within the past few hours, and his last episode produced a bilious vomitus. He has not been able to eat since then. He has passed loose stools that were admixed with blood and mucus. He has no other medical problems. His temperature is 37.5º C (99.5ºF) and pulse is 116/min. He appears dehydrated and apathetic. Examination reveals a distended abdomen with increased bowel sounds. On palpation, the abdomen is soft and very tender. There is no rebound tenderness, but a tender, sausage-shaped abdominal mass is palpated on the right side. Rectal examination reveals a small amount of bleeding. Plain x-ray of the abdomen reveals widespread distention of the bowel loops. The patient receives intravenous hydration. Which of the following is the most likely diagnosis?
A) Inflammatory bowel disease (IBD)
B) Meckel’s diverticulum
C) Acute gastroenteritis
D) Appendicitis
E) Intussusception
zkadhem - 07-24-09 09:42
A 19-month-old Caucasian boy is brought to the emergency department. According to his mother, he has been constantly crying, and this is apparently due to intermittent abdominal pain. From time to time, he draws up his legs and pulls them towards his abdomen. His symptoms began ten hours ago. He has vomited at least four times within the past few hours, and his last episode produced a bilious vomitus. He has not been able to eat since then. He has passed loose stools that were admixed with blood and mucus. He has no other medical problems. His temperature is 37.5º C (99.5ºF) and pulse is 116/min. He appears dehydrated and apathetic. Examination reveals a distended abdomen with increased bowel sounds. On palpation, the abdomen is soft and very tender. There is no rebound tenderness, but a tender, sausage-shaped abdominal mass is palpated on the right side. Rectal examination reveals a small amount of bleeding. Plain x-ray of the abdomen reveals widespread distention of the bowel loops. The patient receives intravenous hydration. Which of the following is the most likely diagnosis?
A) Inflammatory bowel disease (IBD)
B) Meckel’s diverticulum
C) Acute gastroenteritis
D) Appendicitis
E) Intussusception
The correct answer and explanation will be available after you answer.
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#3
Re: abdominal pain and constant crying conym5 - 07-25-09 08:53 My answer is: e.
Early symptoms can include nausea, vomiting - sometimes bile stained (green colour), pulling legs to the chest area, and intermittent moderate to severe cramping abdominal pain. Later signs include rectal bleeding, often with red currant jelly stool (stool mixed with blood and mucus), and lethargy. Physical examination may reveal a sausage-shaped mass felt upon palpation of the abdomen.
In children or those too young to communicate their symptoms verbally, they may cry, draw their knees up to their chest or experience dyspnea (difficult or painful breathing) with paroxysms of pain
#17
Re: abdominal pain and constant crying babbu5508 - 08-30-10 00:50 My answer is: e.
intussusception...with sausage shaped mass, red curant jelly like stools, peractive bwel sounds in initial staes...urgent treatment needed to prevent bowel schemia.
#21
Re: abdominal pain and constant crying sudha2015 - 12-24-10 09:47 My answer is: e.
more common in children specially in boys.there is distnded bowel loops.vomiting n nt able 2 eat food
#23
Re: abdominal pain and constant crying babbu5508 - 02-22-11 10:28 he intussusception can be treated with either a barium or water-soluble contrast enema or an air-contrast enema, which both confirms the diagnosis of intussusception, and in most cases successfully reduces it.
#25
Re: abdominal pain and constant crying babbu5508 - 03-31-11 12:40 If it cannot be reduced by an enema or if the intestine is damaged, then a surgical reduction is necessary. In a surgical reduction, the abdomen is opened and the part that has telescoped in is squeezed out (rather than pulled out) manually by the surgeon
#27
Re: abdominal pain and constant crying humararafiq - 05-17-11 06:25 My answer is: e.
most appropriate
#31
Re: abdominal pain and constant crying asrabukhari - 06-14-11 08:05 My answer is: e.
all clinical presentation sausage shape
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