Question

An 11-year-old girl presents to the emergency department with a 12-hour history of severe abdominal pain. She says that the pain started near the middle of her abdomen and moved to the right lower quadrant after about 10 hours. Several hours after the pain started she also started experiencing nausea and loss of appetite. On presentation, her temperature is 102.5°F (39.2°C), blood pressure is 115/74 mmHg, pulse is 102/min, and respirations are 21/min. Physical exam reveals rebound tenderness in the right lower quadrant. Raising the patient's right leg with the knee flexed significantly increases the pain. Which of the following is the most common cause of this patient's symptoms in children?

a. Fecalith obstruction
b. Ingestion of indigestible object
c. Lymphoid hyperplasia
d. Meckel diverticulum
e. Parasitic infection

Answer 1

The symptoms suggest the patient likely suffers from appendicitis, most commonly caused by fecalith obstruction in children.

Step-by-step explanation:

The most common cause of the symptoms presented by the 11-year-old girl, which include severe abdominal pain that started near the middle of the abdomen and migrated to the right lower quadrant, nausea, loss of appetite, fever, and rebound tenderness in the right lower quadrant, is fecalith obstruction.

This presentation is typical of appendicitis, a condition frequently caused by obstruction due to a fecalith, or hardened stool. This obstruction leads to inflammation and potential infection of the appendix. The patient's symptoms, specifically the movement of pain to the right lower quadrant and the presentation with rebound tenderness and fever, suggest acute appendicitis as the most likely diagnosis. It's key to conduct a prompt examination and potentially apply imaging techniques like ultrasound or CT scanning to confirm the diagnosis and proceed with treatment, which usually involves surgical removal of the affected appendix.