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American Academy of Pediatrics
Index of Suspicion

Index of SuspicionCase 1: Abdominal Pain and Coffee Ground Emesis in a 9-year-old BoyCase 2: Vomiting, Headache, and Seizures in a 7-year-old BoyCase 3: Primary Amenorrhea in a 15-year-old Girl

Thomas C. Martin, Heather Harle, Rachel Dawson, Joshua M. Careskey, Sean Rose, Howard P. Goodkin and Shana Hansen
Pediatrics in Review May 2011, 32 (5) 209-214; DOI: https://doi.org/10.1542/pir.32-5-209
Thomas C. Martin
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Heather Harle
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Rachel Dawson
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Joshua M. Careskey
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Sean Rose
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Howard P. Goodkin
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Shana Hansen
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  • Frequently Used Abbreviations

    ALT:
    alanine aminotransferase
    AST:
    aspartate aminotransferase
    BUN:
    blood urea nitrogen
    CBC:
    complete blood count
    CNS:
    central nervous system
    CSF:
    cerebrospinal fluid
    CT:
    computed tomography
    ECG:
    electrocardiography
    ED:
    emergency department
    EEG:
    electroencephalography
    ESR:
    erythrocyte sedimentation rate
    GI:
    gastrointestinal
    GU:
    genitourinary
    Hct:
    hematocrit
    Hgb:
    hemoglobin
    MRI:
    magnetic resonance imaging
    WBC:
    white blood cell
  • Case 1 Presentation

    A 9-year-old boy presents to the ED with severe abdominal pain and vomiting. He has no history of diarrhea, fever, chills, rash, trauma, arthralgia, or headache. He has no prior history of gastrointestinal complaints or other chronic illnesses. He cannot tolerate clear liquids and is admitted for observation. He vomits coffee ground material and then blood.

    On physical examination, his temperature is 38.5°C, heart rate is 140 beats/min, blood pressure is 123/83 mm Hg, and respiratory rate is 24 breaths/min. He is uncomfortable and diaphoretic. He has tachycardia, but his cardiopulmonary examination results are normal otherwise. He has generalized abdominal tenderness, with guarding and rebound tenderness most pronounced in the periumbilical region and extending to the right lower quadrant. Hip abduction elicits pain.

    CBC documents a normal Hgb value and platelet and leukocyte counts, with a left shift and 78% neutrophils. Urinalysis shows moderate blood and trace proteinuria, with 2 RBCs per high-power field. The chest radiograph appears normal. The abdominal radiograph shows a few mildly distended small bowel loops but no radiographic evidence of obstruction. CT scan of the abdomen leads to exploratory laparoscopy and the correct diagnosis.

    Case 2 Presentation

    A 7-year-old developmentally appropriate boy presents to the ED with a 3-day history of forceful vomiting, headache, and reduced oral intake. Several times after vomiting, he had complained of numbness in his hands and feet that lasted several seconds. Two hours after receiving a dose of promethazine prescribed by his pediatrician, he could not be aroused by his parents.

    On arrival at the ED by ambulance, he is initially sleepy and confused. He is afebrile. His blood pressure is 99/74 mm Hg, heart rate is 89 beats/min, and oxygen saturation is 98% in room air. He has no dysmorphic features and no skin findings. His funduscopic findings and extraocular movements are …

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    In this issue

    Pediatrics in Review: 32 (5)
    Pediatrics in Review
    Vol. 32, Issue 5
    1 May 2011
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    Index of SuspicionCase 1: Abdominal Pain and Coffee Ground Emesis in a 9-year-old BoyCase 2: Vomiting, Headache, and Seizures in a 7-year-old BoyCase 3: Primary Amenorrhea in a 15-year-old Girl
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    Index of SuspicionCase 1: Abdominal Pain and Coffee Ground Emesis in a 9-year-old BoyCase 2: Vomiting, Headache, and Seizures in a 7-year-old BoyCase 3: Primary Amenorrhea in a 15-year-old Girl
    Thomas C. Martin, Heather Harle, Rachel Dawson, Joshua M. Careskey, Sean Rose, Howard P. Goodkin, Shana Hansen
    Pediatrics in Review May 2011, 32 (5) 209-214; DOI: 10.1542/pir.32-5-209

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    Index of SuspicionCase 1: Abdominal Pain and Coffee Ground Emesis in a 9-year-old BoyCase 2: Vomiting, Headache, and Seizures in a 7-year-old BoyCase 3: Primary Amenorrhea in a 15-year-old Girl
    Thomas C. Martin, Heather Harle, Rachel Dawson, Joshua M. Careskey, Sean Rose, Howard P. Goodkin, Shana Hansen
    Pediatrics in Review May 2011, 32 (5) 209-214; DOI: 10.1542/pir.32-5-209
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