• NS is a 7 year-old boy who was brought by his mother with marked abdominal distention, cough and shortness of breath.
• NS is the fourth of seven children.
• He appears small for his stated age of 7 years.
• Vital signs
• Temperature = 101.2°F
• Pulse = 114/min and regular
• Respirations = 26 and mildly labored
• Physical findings
• PERLA, no localizing neurological signs
• Two small ulcers are noted in the mouth
• Profound abdominal distention

Photo courtesy of Kit Biomedical

• Hepatomegaly
and splenomegaly; note marks on his abdomen.
• Roll the cursor over the image
• Good peripheral pulse, but generalized extremity wasting.