C. García Mauriño, A. Molina García
Residentes hospital infantil universitario La Paz
3. Role Play: Abdominal pain. Outpatient appointment.
Doctor: Hello, I’m Doctor Simmons. You’ve been given an appointment because last week you presented to the emergency room with your son, with a history of abdominal pain is that right?
Mother: Yes, I’ve been visiting many hospitals, but no one seems to understand my son’s illness.
Doctor: Tell me, when did it all start?
Mother: Since two months ago he has had stomach pain, which usually lasts 3 hours and then goes away by itself. At first, I wasn’t sure if it was real, because he complained but kept doing his normal every day activities. The thing is, the boy kept complaining day after day, and so I decided I should take him to be examined, just in case it was something bad.
Doctor: Has this pain been persistent in time? Does it hurt every day? Can you describe a pattern?
Mother: Well; the first couple of weeks it was during the afternoons, when he came back from school, but it became gradually less regular appearing even during the night, waking him up from sleep.
Doctor: Did the pain associate vomiting, fever, diarrhea or any urinary tract symptoms?
Mother: No, he has never vomited, but its true that last week he had loose stools for a couple of days. What I do have noticed is that he has less appetite than before.
Doctor: Have you noticed any recent weight loss?
Mother: Not really.
Doctor: Have any test been performed by any other physicians, or pills prescribed?
Mother: Yes, one of the doctors we saw tested his blood and urine and said everything was normal. He prescribed some antibiotics, but I never gave them to him.
Doctor: Although the symptoms you described, and the history of the abdominal pain, didn’t seem to correlate with any severe disease, during the examination we have found some abnormal signs, and we would like to perform an abdominal ultrasound apart from repeating both the urine and blood tests, in order to be able to identify what is causing the pain.
Good general condition. Well hydrated. Slightly obese.
Cardiac auscultation: regular, no heart murmur.
Pulmonary auscultation: good bilateral ventilation, no wheezes, ronchi or rubs.
HEENT: normal tonsils. Normal tympanic membranes. No adenopathy.
Abdomen: soft. Bowel sounds present, no bruits. Flat, not distended. Liver edge, spleen and kidney not felt. No masses. Slightly painfull with focal tenderness in the left flank. No rebound tenderness.
Neurological: awake, alert, and fully orientated.
Outpatient appointment: cita en consultas externas.
Presented to the emergency room: consultar en urgencias.
Stomach pain: dolor de tripa.
Normal every day activities: actividades de la vida diaria.
Loose stools: deposiciones líquidas.
Weight loss: pérdida de peso.
Rubs: roce pleural.
Bowel sounds present: ruidos hidroaéreos presentes.
No bruits: no soplos abdominal.
Liver edge: reborde hepático.
Focal tenderness: defensa abdominal localizada.
No rebound tenderness: Blumberg negativo.
Abdominal ultrasound: ecografía abdominal.