Match each clinical presentation of an acute abdomen to its most appropriate initial management or definitive surgical intervention.
- A 45-year-old female presents with right upper quadrant pain and fever (38.5°C). Physical exam shows focal tenderness that arrests inspiration upon deep palpation. Ultrasound demonstrates pericholecystic fluid and a thickened gallbladder wall.Laparoscopic cholecystectomy
- A 22-year-old male presents with anorexia and periumbilical pain that later migrated to the right lower quadrant. His temperature is 38.0°C, and physical exam reveals marked rebound tenderness at McBurney's point.Appendectomy
- A 60-year-old male presents with sudden onset, severe, and diffuse abdominal pain. He is hypotensive (90/60 mmHg) and tachycardic, with a rigid, board-like abdomen. Upright chest X-ray reveals free air under the right hemidiaphragm.Emergent exploratory laparotomy
- A 65-year-old female with a history of a total abdominal hysterectomy presents with crampy abdominal pain, bilious vomiting, and obstipation. She is hemodynamically stable without peritonitis. CT scan shows dilated loops of small bowel with a transition point.Nasogastric tube decompression and intravenous fluids
Answer
The clinical presentations match their standard management: acute cholecystitis with laparoscopic cholecystectomy, acute appendicitis with appendectomy, perforated viscus with emergent exploratory laparotomy, and uncomplicated small bowel obstruction with nasogastric decompression and intravenous fluids.
Each presentation describes a classic, textbook scenario of a common surgical condition. The paired intervention represents the gold-standard initial management step according to widely accepted surgical guidelines.
Step-by-Step Solution
Key Concept
Surgical management principles for common causes of an acute abdomen
Estimated Time:1m 0s