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Your comprehensive assessment of 16-month-old toddler’s symptoms demonstrates a thoughtful approach to medical evaluation.

Your comprehensive assessment of 16-month-old toddler’s symptoms demonstrates a thoughtful approach to medical evaluation.

Pls response to Ms. Man. S to this Discussion Board-2nd response.

Your comprehensive assessment of 16-month-old toddler’s symptoms demonstrates a thoughtful approach to medical evaluation. I agree with you that, constipation may be less likely as the primary diagnosis due to the absence of key symptoms like hard dry stools. Abdominal examination findings don’t strongly support constipation as the primary cause, as the right lower abdomen is described as “scaphoid” and “empty,” contradicting the expected physical findings of constipation. This could lead to abdominal distension and firmness.

Your understanding of incarcerated hernia characteristics, including bilious vomiting and a prolonged development period, helps rule out the diagnosis based on the patient’s presentation. I just want to add this, An incarcerated hernia involves a small bowel protruding into the groin area, causing organs to protrude through weakened abdominal wall or incomplete inguinal ring closure (Tarantino, C. 2023). However, the case presentation does not suggest an incarcerated hernia, as the abdomen is described as soft and non-distended, without visible hernia or bulge. Intermittent symptoms are absent, and the non-distended abdomen does not suggest abdominal distension. No sign of bowel obstruction is present, and no visible gastrointestinal changes are mentioned.

Thank you also for the very informative details about Malrotation with Volvulus. The patient’s abdominal pain and leg drawing up are similar to Malrotation with Volvulus symptoms, which may result from intestinal twisting. However, the absence of diarrhea, constipation, and vomiting bile deviates from typical Malrotation with Volvulus symptoms. This highlights the need for considering differential diagnoses to explain the child’s symptoms, particularly sudden pain and irritability. Clinical judgment requires recognizing both presence and absence of various signs and symptoms for accurate diagnosis.

We both come up with the idea that Intussusception is the most likely diagnosis due to its well-founded reasoning and clinical features. The classic presentation involves acute pain in a healthy child, while the ‘Dance Sign’ highlights the child’s double-over and pull-ups during pain episodes. The hallmark physical findings in intussusception are a right hypochondrium sausage-shaped mass and emptiness in the right lower quadrant (Dance sign). This mass is hard to detect and is best palpated between spasms of colic, when the infant is quiet. Abdominal distention frequently is found if the obstruction is complete (Chanine, A. 2018). The progression of intussusception over time is commendable, with lethargy, currant-jelly stool, and vomiting being key features of advanced intussusception. Overall, intussusception is a well-supported primary diagnosis in medical literature.

I also agree with your Next appropriate steps in management. Referring a child to the Emergency Room ensures prompt specialized medical attention, collaborating with pediatrician surgeons and GI doctors for evaluation and management decisions. Intussusception involves telescoping or invagination of the intestine, compromising blood flow, leading to tissue damage and necrosis. Prolonged ischemia can cause tissue death, perforation, and peritonitis, requiring prompt evaluation and intervention. While non-surgical reduction is preferred, surgical intervention is still considered for necessary cases. Priority is ensuring the child’s well-being and preventing complications. Ultrasound is the preferred test for diagnosing intussusception due to its advantages in real-time imaging, visualization of invagination, identification of location and extent, non-invasiveness, quickness, efficiency, dynamic assessment of blood flow, and operator dependence (Hwang, J. 2023). It provides real-time images, allowing healthcare providers to observe the abdominal area dynamically, which is crucial for intussusception. I agree that Tylenol liquid can manage pain in children with intussusception, but should be administered under healthcare professional guidance, focusing on diagnosing and treating the underlying condition promptly.

Reference:

Chahine, A. A., MD. (n.d.-c). Intussusception: practice essentials, background, etiology and pathophysiology. https://emedicine.medscape.com/article/930708-overview

Hwang J, Yoon HM, Kim PH, Jung AY, Lee JS, Cho YA. Current diagnosis and image-guided reduction for intussusception in children. Clin Exp Pediatr. 2023 Jan;66(1):12-21. doi: 10.3345/cep.2021.01816. Epub 2022 Jul 4. PMID: 35798026; PMCID: PMC9815940.

Jain S, Haydel MJ. Child Intussusception. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431078/


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