An 8-year-old boy presents to the emergency department (ED) with right upper abdominal pain associated with vomiting, headache, and fever. The boy had been seen in the ED approximately 1.5 months previously for a sore throat, cough, and headache. After the first visit to the ED, the patient was treated with amoxicillin. The boy was born in northern Africa in a refugee camp. He and his family had emigrated from Africa approximately 8 months ago. Generally the boy appears to be in good health. His immunizations are current, and he has no allergies. He currently resides with his parents and three siblings, who all appear to be in good health. His mother speaks very little English. The attending physician orders an abdominal computed tomography (CT) scan and identifies a mass in the left hepatic lobe. There appears to be no evidence of gastrointestinal bleed-ing. The attending physician orders a complete work-up on the patient, including a complete blood count, microbiology tests, chemistry, coagulation, and a hepatitis panel. The laboratory results indicate some type of infection and inflammatory condi-tion. The patient has an elevated white blood cell (WBC) count that correlates with his erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level. The ESR and the CRP level are clear indicators of an inflammatory process. QUESTIONS Identify and differentiate the patient's signs and symptoms.

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An 8-year-old boy presents to the emergency department (ED) with right upper abdominal pain associated with vomiting, headache, and fever. The boy had been seen in the ED approximately 1.5 months previously for a sore throat, cough, and headache. After the first visit to the ED, the patient was treated with amoxicillin. The boy was born in northern Africa in a refugee camp. He and his family had emigrated from Africa approximately 8 months ago. Generally the boy appears to be in good health. His immunizations are current, and he has no allergies. He currently resides with his parents and three siblings, who all appear to be in good health. His mother speaks very little English.

The attending physician orders an abdominal computed tomography (CT) scan and identifies a mass in the left hepatic lobe. There appears to be no evidence of gastrointestinal bleed-ing. The attending physician orders a complete work-up on the patient, including a complete blood count, microbiology tests, chemistry, coagulation, and a hepatitis panel. The laboratory results indicate some type of infection and inflammatory condi-tion. The patient has an elevated white blood cell (WBC) count that correlates with his erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level. The ESR and the CRP level are clear indicators of an inflammatory process.
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Identify and differentiate the patient's signs and symptoms.
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