Abdominal Pain in Cystic Fibrosis
Abdominal Pain in Cystic Fibrosis
Per K.B. in the emergency department (ED), "My stomach hurts."
The mother of K.B., a 5-year-old girl with cystic fibrosis (CF), calls the CF nurse practitioner (NP) following a visit to the ED the previous day. K.B.'s mother reports by phone that K.B. has had intermittent severe right lower quadrant abdominal pain for 2 days followed by fever up to 102ºF and was seen in the ED, where an abdominal radiograph revealed constipation. She was given two enemas and was sent home after having a large bowel movement. This morning K.B. was febrile again with a temperature of 101ºF with continued abdominal pain not associated with nausea, vomiting, diarrhea, or other symptoms. K.B. has an appointment scheduled for the pediatric gastroenterologist later today, but her mother wanted some ideas as to what might be causing K.B.'s abdominal pain and fever.
Upon obtaining a nutritional history, the mother indicates that K.B. has always been a "picky" eater but eats large quantities of things she enjoys. Her mother has been so focused on K.B.'s pain that this question takes her by surprise as she remembers that K.B.'s appetite has been decreased since Thursday night, when she refused to eat one of her favorite foods, a bacon cheeseburger. The character of K.B.'s stool is per baseline and is described as large, bulky, and without color change or blood. K.B.'s mother denies any associated neurologic, sinus, pulmonary, or musculoskeletal symptoms.
Chief Complaint and History of Present Illness
Chief Complaint
Per K.B. in the emergency department (ED), "My stomach hurts."
History of Present Illness
The mother of K.B., a 5-year-old girl with cystic fibrosis (CF), calls the CF nurse practitioner (NP) following a visit to the ED the previous day. K.B.'s mother reports by phone that K.B. has had intermittent severe right lower quadrant abdominal pain for 2 days followed by fever up to 102ºF and was seen in the ED, where an abdominal radiograph revealed constipation. She was given two enemas and was sent home after having a large bowel movement. This morning K.B. was febrile again with a temperature of 101ºF with continued abdominal pain not associated with nausea, vomiting, diarrhea, or other symptoms. K.B. has an appointment scheduled for the pediatric gastroenterologist later today, but her mother wanted some ideas as to what might be causing K.B.'s abdominal pain and fever.
Upon obtaining a nutritional history, the mother indicates that K.B. has always been a "picky" eater but eats large quantities of things she enjoys. Her mother has been so focused on K.B.'s pain that this question takes her by surprise as she remembers that K.B.'s appetite has been decreased since Thursday night, when she refused to eat one of her favorite foods, a bacon cheeseburger. The character of K.B.'s stool is per baseline and is described as large, bulky, and without color change or blood. K.B.'s mother denies any associated neurologic, sinus, pulmonary, or musculoskeletal symptoms.
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