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A four year-old boy presents to your clinic with abdominal pain for one day. His mother notes that he has had three loose bowel movements over the last several hours, and his temperature earlier that day was 99.8 degrees Fahrenheit. He has not been as playful as usual and does not want to eat. There are no other children in the household, and nobody else in the house is ill. The child was born at term without complications. He is up to date on his immunizations. He has no significant past medical history, has no known allergies, and is taking no medication. Examination reveals a heart rate of 120 (normal heart rate 75-135), a blood pressure of 105/65 (normal blood pressure > 102/62), a respiratory rate of 26 (normal respiratory rate 21-26), and a temperature of 99.5 degrees F. He is appropriately nourished and developed. He is awake and cooperative, though he seems a little sleepy. He is mildly diaphoretic. Pupils are 3 mm and reactive. He has moist mucous membranes. The remainder of the head and neck exam is normal. The heart and lung exams are normal. Abdominal examination elicits moaning from the patient suggestive of diffuse tenderness, though there are normal bowel sounds, no organomegaly, no guarding, and no rebound. Rectal exam shows light brown stool on the glove and is hemoccult negative. The neurological exam is entirely normal.
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