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Qestion? - mounika1980
#1
A six month old well nourished boy is brought to the pediatrician by his mother. She is concerned because on multiple occasion in the past 48 hours, she has discovered evidence of rectal bleeding in her son's diaper. the mother reports that her son has no h/o vomiting excessive, cring or demonstration of discomfort when passing stool she denies any h/o trauma or foreign body ingestion. The boy was born at term via normal spontaneous vaginal delivery and has no pertinent medical history. He is now sitting very quietly in his mother's lap, and appears to be experiencing mild discomfort. His temperature is 37.0C (98.6F), blood pressure is 84/56 mmHg, pulse is 132/min, and respirations are 28/min. His anterior frontanelle is slightly depressed. His abdomen is soft and nontender. There is no hepato splenomegaly. The rectal examination is unremarkable. Immediately after being examined the child passes stool that looks like current and contains gross amounts of blood and mucous. Which of the following dx test would be the best to perform through the emergency department before considering discharge the patient.

a) Abdominal plain film
b) Air or water soluble enema
c) CT scan of abdomen
d) Technetium 99m scan
e) Ultrasound of the abdomen
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#2
may be E
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#3
intussusception
USS abd is the best initial test --> doughnut sign
https://s-media-cache-ak0.pinimg.com/ori...98f8f2.jpg
Air or water soluble enema both diagnostic as well as therapeutic [mainly]
So, I will go for B before discharge
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#4
air water enema can we do in emergency deparment?
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#5
and this is more than 24 hours of symptoms
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#6
Yes, it can be done at ER.
What is your point regarding more than 24 hours symptoms, galveston?
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#7
-US is done whenever the diagnosis is not clear---> Expected findings= Target sign
-Air enema is therapeutic and can be done w/o the need of US when the dx is clear such as this case.
Answer B
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#8
??
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