Description

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.