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By Charles A Pohl

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9. Biliary colic, cholecystitis. Gallstones are most common in adolescent girls; may also occur in children with hemolytic anemias and those who have received long-standing TPN. 10. UTI. Cystitis is usually associated with dysuria, frequency, and urgency; pyelonephritis with fever and flank tenderness. 11. Urinary calculus. May produce excruciating “writhing” pain in flank or abdomen as well as hematuria. 12. Ovarian cyst. Rare before puberty. May produce pain when it bleeds, ruptures, or twists.

Involves terminal ileum and right colon and is probably infectious. 9. Biliary colic, cholecystitis. Gallstones are most common in adolescent girls; may also occur in children with hemolytic anemias and those who have received long-standing TPN. 10. UTI. Cystitis is usually associated with dysuria, frequency, and urgency; pyelonephritis with fever and flank tenderness. 11. Urinary calculus. May produce excruciating “writhing” pain in flank or abdomen as well as hematuria. 12. Ovarian cyst. Rare before puberty.

Textbook of Pediatric Emergency Procedures. Williams & Wilkins, 1997:101–118. 5. ALKALOSIS I. Problem. A 3-week-old male infant has progressively worsening projectile emesis (nonbilious and nonbloody). On physical exam, the infant is tachycardic and lethargic, and has weight loss and slight abdominal distention with a palpable right upper quadrant mass. II. Immediate Questions A. What do physical exam findings say about patient’s hydration status? Vital sign changes (tachycardia) coupled with mental status exam and weight loss indicate severe dehydration in this infant due to hypovolemia from repeated emesis.

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