04-07-2009, 09:41 AM
30. A 14-month-old girl is brought to the physician because of a 14-hour history of irritability and episodes of drawing her knees toward her chest. During this period, she has vomited nonbilious fluid twice and had a bowel movement containing a small amount of blood. She had an upper respiratory tract infection 2 weeks ago. She is listless except for intermittent episodes of discomfort. Her temperature is 38 C (100.4 F). Abdominal examination shows right-sided tenderness without guarding or rebound; bowel sounds are present. Rectal examination shows bright red blood and mucus. An x-ray film of the abdomen shows no abnormalities. Which of the following is the most appropriate next step in management?
A
) X-ray film of the upper gastrointestinal tract with contrast
B
) Water-soluble contrast enema
C
) Corticosteroid enemas
D
) Admission to the hospital for total parenteral nutrition
E
) Immediate laparotomy
A
) X-ray film of the upper gastrointestinal tract with contrast
B
) Water-soluble contrast enema
C
) Corticosteroid enemas
D
) Admission to the hospital for total parenteral nutrition
E
) Immediate laparotomy