I want to recognize Cortney Nelson for her great pick up last night. I signed up for a 9-year-old female previously healthy presenting with fever, vomiting, diarrhea... sounds like acute gastroenteritis, right?
Cortney alerted me before I went into the room that the child had a "mass" in her left upper quadrant. Cortney felt it when she examined the child. And she told me that both parents have sickle cell trait, but the child did not have a known sickle cell diagnosis. Long story short, the kid actually did have splenomegaly. And ended up having a sickle cell disease that we diagnosed! She did get admitted for dehydration and heme work up. It is rare to diagnose sickle cell disease in a 9-year-old!
Great physical exam skills and history taking on Cortney's part and for alerting me.