Thank you to Dr. Vazquez for this case.
You are working in the peds ED, a full term 3 day old presents with bilious vomiting after each feed x 1 day associated with increasing abdominal distension. No pertinent birth or maternal history. Also noted to have mild jaundice from head to toe. Per mother patient is having normal wet diapers, no fevers, passed 2 meconium stools after birth but has not had a bowel movement in 24hrs. Normal activity.
VS: 140, 100/60, 36, 100% RA
Gen: NAD, well appearing, active
HEENT: mild scleral icterus, mucous membranes moist, TMs wnl b/l
CVS: RRR no m/r/g
Resp: CTAB, normal effort, no retractions
Abd: normal bowel sounds, distended, tympanitic, patient cries on palpation diffusely, no hepatosplenomegaly
Ext: warm, well perfused, normal cap refill
DRE: no stool in the vault, however, when you remove your finger, patient has explosive gas and stool.