Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 4 year old male brought to the clinic by his mother due to abdominal pain. The mother states that her child has been having stools less frequently for the past few weeks, and he complains that his tummy hurts when trying to defecate. She states that her child only has 2-3 stools per week. When he does have a bowel movement, the stool is very large. Her son appears in distress when using the bathroom, and he seems to have started avoiding the bathroom. He has never had problems with constipation before, and he passed meconium within the first 24 hours of birth. She denies any hematochezia, melena, vomiting, or nausea. She has not introduced any new food items into his diet. He eats the same food as the rest of the family—whole grain cereals, low-fat dairy, lean meats, fruits and vegetables. He did just recently start preschool.
VS- Temp 98.6, HR 110, BP 100/60, RR 28, Height 101cm, Weight 16kg.
General- Alert. No acute distress. Playing with toys.
HEENT- Normocephalic, PERRLA, normal tympanic membranes, nose and oropharynx normal
Abdomen- Bowel sounds present. No tenderness to light or deep palpation. Mild abdominal distension.
Rectal- Rectum is enlarged and stool is present in rectal vault