Review Question - QID 109246

A 46-hour-old female is evaluated in the hospital nursery for difficulty feeding. Her mother reports that breastfeeding was going well for the first several feeds, but the patient now seems less interested in feeding and refuses to latch. A few minutes later, the patient has two episodes of biliary emesis. She has not yet had a bowel movement. The patient was born at 37 weeks gestation to a 39-year-old gravida 4. The pregnancy was uncomplicated. The patient’s family history is significant for a maternal uncle who died in his late 20's due to pulmonary disease. The patient’s father was adopted, and little is known about his biological family. The patient’s three older siblings are healthy. The patient’s temperature is 97.8°F (36.6°C), blood pressure is 62/44 mmHg, pulse is 140/min, and respirations are 36/min. On physical exam, the patient is crying, and her abdomen is markedly distended. There is no stool in the rectal vault on digital rectal exam. An abdominal radiograph is performed and can be seen in Figure A. A contrast enema is scheduled.
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