Differential Diagnosis
- Single most likely diagnosis
- Viral Hepatitis: The "starry sky" pattern on ultrasound is suggestive of hepatitis, and the patient's symptoms such as vomiting and tenderness in the bilateral lumbar areas (possibly indicating liver or spleen involvement) support this diagnosis. The elevated TLC (Total Leukocyte Count) with a predominance of neutrophils could be seen in various infections, including viral hepatitis.
- Other Likely diagnoses
- Pyelonephritis: The patient's symptoms of vomiting, high pulse rate (144), and tenderness in the bilateral lumbar areas could also suggest pyelonephritis, an infection of the kidneys. The elevated neutrophil count further supports an infectious process.
- Sepsis: Although the patient is currently stable, the history of vomiting, high pulse rate, and elevated white blood cell count with neutrophilia could indicate an early stage of sepsis, particularly if the vomiting was severe enough to cause dehydration.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although less likely given the ultrasound findings and the location of tenderness, appendicitis can sometimes present with atypical symptoms, especially in children. It's crucial to consider this diagnosis due to its potential for severe complications if not promptly treated.
- Hemolytic Uremic Syndrome (HUS): This condition, often following a bacterial infection (like E. coli), can lead to acute kidney failure. The patient's vomiting and abdominal tenderness could be initial symptoms, making it a critical diagnosis not to miss.
- Rare diagnoses
- Wilson's Disease: This rare genetic disorder can cause liver disease and might present with abdominal symptoms. However, it would be less likely given the acute presentation and the specific ultrasound findings.
- Leptospirosis: A zoonotic infection that can cause liver and kidney dysfunction among other symptoms. It's rare and would depend on the patient's exposure history, but it could explain some of the patient's symptoms.