Match each distinct clinical presentation of acute or subacute abdominal pain to its most accurate surgical diagnosis or underlying etiology.
- Sudden onset of severe, unrelenting periumbilical pain out of proportion to physical examination findings in a patient with an irregular heartbeat.Acute arterial thromboembolism
- Gradual onset of diffuse abdominal pain over several days in a patient with an underlying myeloproliferative neoplasm.Mesenteric venous thrombosis
- Development of abdominal distension, feeding intolerance, and lactic acidosis in a critically ill patient recovering from septic shock on high-dose norepinephrine.Nonocclusive mesenteric ischemia (NOMI)
- Recurrent, dull postprandial abdominal pain leading to an aversion to eating and profound weight loss in a heavy smoker.Chronic mesenteric ischemia
- Intermittent, crampy abdominal pain associated with bilious emesis, obstipation, and abdominal distension in a patient with a history of prior laparotomy.Adhesive small bowel obstruction
Answer
The clinical presentations map to their respective etiologies based on acuity of onset, specific risk factors (arrhythmias, hypercoagulability, low flow states, atherosclerosis, or prior surgery), and temporal relationship to meals.
Each presentation uniquely describes a distinct etiology of intestinal compromise. Atrial fibrillation points to embolic arterial ischemia; myeloproliferative disorders to venous thrombosis; vasopressors to nonocclusive ischemia; atherosclerosis/smoking to chronic ischemia; and prior surgeries to adhesive obstruction.
Step-by-Step Solution
Key Concept
Differentiating primary etiologies of mesenteric ischemia and mechanical bowel obstruction based on clinical presentation and specific patient risk factors.