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A 5 year old boy has had increasing abdominal pain over the last 24 hours. He has not vomiting, diarrhea, or other symptoms of illness except for mild decrease in appetite. On physical exam, he appears ill and is in mild distress. Temperature is 38.3 C (102 F), pulse is 112/minute, respirations are 45/minute. Abdominal examination reveals mild tenderness and guarding in the right upper quadrant area. The next best step in management is to obtain:

A. an abdominal ultrasound
B. a chest x-ray
C. a CBC and blood culture
D. serum amylase and lipase
E. a urine culture

PS: it would be nice if you can post why you choose a certain answer and to add your diagnosis to this clinical scenario!


Imaging Studies are preferred.
either X ray to demonstrate sub-diaphragmatic abscess
or Ultrasound for hepatobiliary problem.


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