Review Question - QID 109245

A 2-day-old male is evaluated in the hospital nursery for vomiting. He has vomited three times in the last four hours and now shows little interest in feeding. His mother describes his last episode of emesis as green in color. The patient is sleeping and urinating well, but has not yet passed meconium. The patient was born at 35 weeks gestation to a 42-year-old gravida 3. The patient’s mother received sporadic prenatal care and did not undergo any prenatal testing. His birth weight was 2.80 kg (6 lb 3 oz), and his current weight is 2.30 kg (5 lb 1 oz). The patient’s temperature is 98.8°F (37.1°C), blood pressure is 56/41 mmHg, pulse is 137/min, and respirations are 32/min. On physical exam, he is in mild distress. His abdomen is soft and distended. Digital rectal exam reveals an absence of stool in the rectal vault. His abdominal radiograph can be seen in Figure A. A contrast enema is performed and can be seen in Figure B.
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