A 6-Year-Old Girl With Fever and Abdominal Pain

Nuzhat Ali, MD, and Kyle Smith, MDSeries Editors: Sheryl Falkos, MD, and Rosa A. Vidal, MD


September 21, 2005

Physical Examination

A 6-year-old girl presented to the emergency room with a 3-hour history of left-side abdominal pain and fever. Her mother reported that the patient fell asleep after having dinner, which consisted of refried shrimp rice and broccoli left over from 3 nights prior. Nobody in the house ate the same food. About an hour and a half later, the patient woke up screaming in pain and holding her left side, saying it was hurting. In addition, the mother reported that the child had a fever of 102.6º F 2 days ago, but denied any vomiting, diarrhea, or dysuria. She stated that the patient also had a mild cough and that her last bowel movement was about 2 days ago.

The past medical history was negative.

Vital Signs: Oral temperature 102.8º F, pulse 177, respiratory rate 28/min, blood pressure 132/85 mmHg
Weight: 30.2 kg
Peripheral oxygen saturation on room air: 98%

General Appearance: The patient is alert and appears to be in moderate distress, holding her left side and curled up in the fetal position

Cardiovascular: Regular heart rate and rhythm

Respiratory: Breath sounds clear on auscultation bilaterally

Abdomen: Soft, with moderate tenderness to deep palpation over the left lower quadrant; bowel sounds audible, without hepatosplenomegaly or costovertebral angle tenderness.

The remainder of the physical examination was within normal limits.


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