A 13-year-old girl presented with 5 days of abdominal pain that originated in her right upper quadrant and progressed to her epigastrium. She denied experiencing nausea, vomiting, diarrhea, loss of appetite, fevers, or chills. She was afebrile. Her abdomen was tender to palpation in the midepigastrium, but without rebounding or guarding. White blood cell count and lipase and liver function test results were normal. Her weight was 64.7 kg (~ 90th percentile for age), and her height was 158 cm (~ 50th percentile). Figures 1 and 2 are images from her abdominal computed tomographic (CT) scan.
Axial computed tomography through the patient's upper abdomen at the level of the kidneys. Triangular area of radiodense omental fat (arrows) is seen anteriorly within the right abdomen.
Two-dimensional coronal reconstruction of abdominal computed tomography. Note the position of the triangular hazy gray density (arrows) in relation to the stomach and the transverse colon (arrowhead).
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The Rational Clinical Examination
Make the Diagnosis: Opiates and Abdominal Pain
The Rational Clinical Examination
Original Article: Do Opiates Affect the Clinical Evaluation of Patients With Acute Abdominal Pain?
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