Peds: Day 5

My first day of Inpatient Peds is complete! Was in from 8-6...hours look a lot like surgery, I'm not keen! Pretty friendly environment...no real complaints as of yet.

I have seen so many kids with croup its crazy. It's the beginning of the croup season, and we have a lot of kids on our service with it. I also saw a lot of kids admitted due to asthma exacerbation. One child had Acute Disseminated Encephalomyelitis due to a previous viral infection...kinda scary to think of the illnesses that some children have even if he/she is otherwise healthy.

My patient is a cute little 5-month old boy with intermittent, severe abdominal pain. He vomited 8 times prior to admission (which happened early this morning). His CBC was within normal limits. He currently is running a fever of 103, and is smiling and mobile until a painful attack makes him cry and pull up his legs towards his abdomen. He has not had a bowel movement in 3 days, and his urine output is decreased despite adequate rehydration. Our main concern for this little boy is intussusception, which is a "telescoping" of the intestines. This happens when a portion of intestine, most commonly the end of the small intestine, telescopes into the lumen of the next segment of bowel, most commonly the cecum, which can lead to painful episodes and bloody/mucous stool (the pathogomonic "currant jelly stools"). This is often a clinical diagnosis, and the treatment is to give the patient an enema, which works by using a retrograde force and attempting to push the intestine back into its proper place. After obtaining an abdominal x-ray showing bowel distension and lack of air in the distal colon as well as performing an unremarkable abdominal ultrasound, we went ahead with the barium enema. When I left today, it was said that the enema study did not support the diagnosis of intussusception, but his temperature was going down and he seemed less fussy. I'm not sure what is going on with him if not intussusception; the differential diagnoses include gastroenteritis among others, so that is always a good fall-back diagnosis. Either way, it was a good way to re-enforce the pathophysiology, etiology, presentation, diagnosis, and treatment of intussusception.

I'll be getting up for work at 6a for the next two weeks - I think I did this to myself when I said how happy I was to have the crazy surgical hours behind me!! Speaking of surgery, I'm happy to say that I did better than I expected on the surgical shelf exam. I'm starting to feel like I really will be a real doctor someday...! ;)