Description

Attempt

Hassan is a 24-month-old male brought into the office by his mother with complaints of abdominal pain x 2 days after falling off the bed during a nap while under the care of her boyfriend. He has a history of Downs syndrome, ASD repair with transient CHF, and global developmental delay. Physical exam reveals tachycardia, tachypnea, hypotension, and lethargy. Skin is cool, clammy, pale, slightly mottled, toe capillary refill 4 seconds, dental carries, and diffuse diaper rash. Bowel sounds are hypoactive, abdomen is distended, and firm with ecchymoses overlying the epigastrium; tenderness on palpitation, guarding and rebound tenderness. Wrists have faint circumferential macular discoloration consistent with aging ligature marks. Pt is afebrile, lungs sounds CTA, no head trauma. Mother states Hassan is often watched by her neighbor and boyfriend while she works.

Attempt

HK a 26-month-old male with past medical history of Down syndrome and s/p AV septal repair with transient CHF and global development delay presents to the clinic with mother who reports a 2-day history of abdominal pain. Per report, mother says her boyfriend admits the patient “fell from the bed during a nap” and has not been the same. Patient is often left in the care of neighbors or mom’s boyfriend while she is at works. Physical exam is positive for tachycardia, tachypnea, hypotension, and lethargy; skin is pale, cool, clammy, and slightly mottled, with toe capillary re…ll of 4 seconds, dental caries, and diffuse diaper rash. Hypoactive bowel sounds, abdominal distention, 昀椀rm, with ecchymoses overlying the epigastrium area; tenderness on palpation, guarding, and rebound tenderness. Faint circumferential macular discoloration at wrist consistent with aging ligature marks. Negatives include fever, lung sounds CTA or head trauma noted.

Attempt

H.K. is a 2-year-old male with a medical history significant for Down syndrome and atrial-septal defect that was repaired who was brought into the clinic by his mother for abdominal pain for 2 days with 1 episode of vomiting last night. Mother states that symptoms began after the patient fell from the bed while taking a nap. She states that he has been lethargic, has decreased wet diapers daily with dark and strong-smelling urine and no bowel movement for one day and has had a decrease in appetite. Upon assessment, the patient is listless and has poor eye contact. Skin is pale, cool, and slightly mottled. Diffuse diaper rash noted. Faint circumferential macular discoloration at wrists consistent with aging ligature marks. Ecchymoses overlying epigastrium measuring 10cm in diameter in an oval shape. Hypoactive BS x 3. Distended, firm abdomen. Diffuse tenderness on palpation with associated guarding. 2cm, reducible umbilical hernia. No medications have been given to the patient.