Tutorial 37 - Acute Abdomen II Flashcards
What are abdominal radiographs helpful for? (x3)
- Free air
- Intestinal obstruction
- Radiopaque foreign bodies/ingestions
When an AXR is ordered, a series of 3 films is usually ordered. What types of films are ordered?
- Supine abdomen
- Upright abdomen
- PA chest
What is the background radiation equivalent of an AXR series?
2 months
A 70-year-old female presents with a 2-day history of generalized abdominal pain, vomiting, and abdominal distension. She has a history of multiple abdominal surgeries, including a colectomy. On examination, her abdomen is distended and tympanic with diffuse tenderness. Bowel sounds are high-pitched.
What is the MOST LIKELY diagnosis?
a. Acute cholecystitis
b. Acute pancreatitis
c. Bowel obstruction
d. Mesenteric ischemia
e. Bowel perforation
Answer: c. Bowel obstruction
Rationale: The history of prior surgeries and symptoms of abdominal distension and high-pitched bowel sounds suggest a bowel obstruction, likely due to adhesions from previous surgeries.
You are assessing a patient with sudden onset hypotension after an upper endoscopy. The patient is pale, febrile, mottled, and has a diffusely tender, peritonitic abdomen with signs of shock.
What is the MOST LIKELY diagnosis?
Options:
a. Ruptured AAA
b. Bowel perforation
c. Bowel obstruction
d. Upper gastrointestinal hemorrhage
e. Mesenteric ischemia
Dr Yusuf - can you review? Want to make sure that this is clear that the bowel perf / fever / shock is clear.
Answer: b. Bowel perforation
The patient is showing signs of septic shock with a peritonitic abdomen, which is highly suggestive of a bowel perforation. The presence of diffuse tenderness and peritoneal signs following an endoscopic procedure raises the suspicion of a perforated viscus.
A 50-year-old male presents with severe, colicky right flank pain that radiates to his groin. He reports nausea but no vomiting. He denies any fever or change in bowel habits. On examination, there is tenderness in the right flank but no peritoneal signs.
Which test would be MOST HELPFUL to confirm your diagnosis?
a. Abdominal x-ray
b. Ultrasound of the kidneys
c. CT scan of the abdomen and pelvis
d. MRI of the abdomen
e. Intravenous pyelogram
Answer: c. CT scan of the abdomen and pelvis
Rationale: The presentation of colicky flank pain radiating to the groin suggests nephrolithiasis. A CT scan without contrast is the gold standard for detecting kidney stones.
A 60-year-old male with a history of multiple abdominal surgeries presents with crampy abdominal pain, vomiting, and a distended abdomen. He reports passing no flatus or stool for 2 days.
What is the most likely risk factor contributing to this patient’s condition?
a. Inflammatory bowel disease
b. Previous abdominal surgery
c. Hypertension
d. Chronic alcohol use
b. Previous abdominal surgery
A 70-year-old male with a known history of smoking and hypertension presents with sudden onset of severe abdominal pain radiating to his back. He is hypotensive and pale. Physical exam reveals a pulsatile abdominal mass.
Which risk factors does this patient have that increase the likelihood of an abdominal aortic aneurysm rupture?
- Age > 70
- Male
- History of hypertension
- History of smoking
A 50-year-old male presents with sudden, severe abdominal pain and rigidity. He has a history of peptic ulcer disease and NSAID use. On exam, his abdomen is rigid with guarding.
Which is the most likely cause of this patient’s presentation?
Bowel perforation (secondary to peptic ulcer)
A 40-year-old woman presents with right upper quadrant pain, fever, and vomiting after eating a fatty meal. On examination, she has a positive Murphy’s sign.
What is the most appropriate next step in diagnosing this patient’s condition?
a. Abdominal x-ray
b. Abdominal ultrasound
c. CT scan of the abdomen
d. MRI of the abdomen
b. Abdominal ultrasound
A patient with chronic diarrhea and weight loss presents for evaluation. What is the most appropriate next test to confirm the diagnosis of IBD?
Colonoscopy with intestinal biopsy.
Which of the following is the most significant risk factor for cholecystitis in a 45-year-old woman with right upper quadrant pain that began after eating a fatty meal?
A) History of obesity
B) History of NSAID use
C) History of smoking
D) History of liver disease
Dr. Yusuf - can you make more appropriate for test questions?
Answer: A) History of obesity
Which of the following is a positive predictor for acute mesenteric ischemia?
A) Severe abdominal pain with metabolic acidosis
B) Pain relieved by eating
C) Absent bowel sounds
D) Pulsatile abdominal mass
A) Severe abdominal pain with metabolic acidosis
A 52-year-old woman presents to the emergency department with a 2-day history of dull, constant pain in her right upper quadrant that started about an hour after eating a fatty meal. She has felt nauseated but has not vomited, and she reports a low-grade fever. On examination, her abdomen is soft, with mild tenderness on deep palpation of the right upper quadrant but no guarding or rebound tenderness. She has no history of gallstones, but she is obese and recently started a high-protein diet to lose weight. Bowel sounds are normal, and she denies any diarrhea or blood in her stool. The patient has a fever of 38.9°C.
What test would confirm the diagnosis?
What is the appropriate treatment for this patient?
Dr. Yusuf - for the treatment (given that she has a fever) - would you say IV antibiotics and cholecystectomy?
Tests to confirm diagnosis: Abdominal ultrasound
Treatment: antibiotics, cholecystectomy
A 72-year-old male with a history of hypertension and chronic kidney disease presents to the emergency department with sudden onset of severe, diffuse abdominal pain that began 4 hours ago. He describes the pain as constant and unrelenting. He denies any recent changes in bowel habits, and he has no vomiting or diarrhea. His pulse is irregular, and his heart rate is 110 bpm. His blood pressure is 95/60 mmHg. On physical examination, his abdomen is soft, non-distended, and minimally tender without rebound tenderness or guarding. Bowel sounds are normal.
What is the best test to rule in the most likely diagnosis?
Dr. Yusuf - please modify as needed to ensure that the answer is obviously acute mesenteric ischemia.
CT angiography without oral contrast
