CASE CONFERENCE. Sept. 14, 2011 Vincent Patrick Tiu Uy, MD. 5 year old male presents to the emergency department with ABDOMINAL PAIN. HISTORY OF PRESENT ILLNESS.
Sept. 14, 2011
Vincent Patrick Tiu Uy, MD
5 year old male presents to the emergency department with ABDOMINAL PAIN
HISTORY OF PRESENT ILLNESS ABDOMINAL PAIN
Intermittent episodes of vague abdominal painlocalized at the periumbilical area. The pain was mild and the child can tolerate.
Episodes of NBNB emesis x 3
Denies fever, weakness
Poor appetite, otherwise hydrated
1 week PTC
Vomiting x 3-5
Pain became continuous, diffused, and severe
Graded 10/10 on FACES.
Several episodes of vomiting this time bilious
No appetite; child refuses to drink anything
Child became sicker
Few hours PTC
Complete Blood Count
A 9 day old baby girl presents to you with jaundice. The mom noticed yellowing of the skin and eyeballs since she was 4 days old. A work-up was done which showed total bilirubin levels to be elevated at 15 mg/dL. The direct bilirubin was 20% of the TSB. There were no abnormalities in the physical examination.
Mom asks you: “What do you think it is?”
A 10 year old boy was brought to the ED with abdominal pain. There was diffuse tenderness and a palpable mass over the right upper quadrant. USG revealed a fusiform choledochal cyst. MRCP was done. The radiologist reading the study mentions an abnormal pancreatico-biliary junction and quizzes the residents: “With the pancreatic duct joining the CBD X cm. before reaching the duodenum.”
What is a possible value for X to justify the reading?