### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Took my otherwise healthy 6.1, slender, athletic, 16 year old son to the ER with abdominal pain whicChatDoctore on gradually then moderate to severe within about an hour.  He started to throw up when we go to the ER and became pale.  A type of Cat scan through the rectum showed enlarged lymph nodes and his blood work showed  a high lymphocyte count, along with cloudy urine.  His temperature stayed a little over 98 degrees and no diarrhea.  The doctor sent him home with pain and nausea medication and said return if he spikes a fever and /or pain gets worse.  He is still tender to the touch and sleeping most the day, normally very active doing card type workouts.  He is tall and slender, with not much body fat, and the doctor said it is makes the test procedure more uncomfortable and difficult to be too conclusive counting out an appendicitis.  Could this be just a virus since the pain is more uncomfortable and tender to the touch below his belly button and to his right?  Wouldnt a virus cause a fever?

### output:

Hi. Thanks for your query and an elucidated history. This is a typical situation where the young present with pain in abdomen and associated severe problems like falling pale. Since the CT scan has shown the enlarged lymph nodes, the diagnosis is certainly related to the lymph nodes. Although there is no diarrhea, lymph nodes should be investigated, if possible get an appointment with interventional radiologist to do an FNAC of the lymph node under ultrasonography guidance. If this fails I would advise getting a course of an antibiotic and anti-inflammatory course for up to 3 weeks, review the lymph nodes by ultrasonography. IF still present, better to do diagnostic laparoscopy and to do a formal biopsy. This does not look to be due to virus as there will be pain and other general symptoms also. Virus may or may not cause fever.