Abdominal Pain In A Recently Immigrated 10-Year-Old Girl

Alexandra Hudson, HBSc*2. Kim Blake, MD* 1. *Dalhousie University, Halifax, Nova Scotia, CanadaA 10-year-old previously healthy girl presents to the emergency department for evaluation of abdominal pain. Five days ago, she developed abdominal pain, which has been worsening. She has no history of fever, constipation, or diarrhea. She reports 4 episodes of nonbilious vomiting. There is no change in the color of her urine. She reports no other symptoms and denies any change in behavior. Her appetite and fluid intake are reported as increased, and she enjoys eating fast food every day. She has recently emigrated with her family from India to Canada. There is no significant family history of hemoglobinopathy or Wilson disease.Physical examination reveals a weight of 118.4 lb (53.7 kg) (90th–97th percentile), height of 60.6 in (154 cm) (90th percentile), and BMI of 22.6 (90th–95th percentile). There is no evidence of hepatomegaly or jaundice. Abdominal examination reveals a soft abdomen with diffuse right upper quadrant tenderness and a negative Murphy sign.Laboratory investigations reveal elevated aspartate aminotransferase (156 U/L [2.61 μ kat/L]) and alanine aminotransferase (81 U/L [1.35 μ kat/L]) enzyme levels, a normal amylase level (66 U/L [1.10 μ kat/L]), and an elevated urobilinogen level (19.4 mg/24 h [33 μ …