Match each patient's clinical presentation of an acute abdomen with the most appropriate next step in management.
- A -year-old man with known stricturing Crohn disease presents with crampy abdominal pain, obstipation, and bilious emesis. Vitals are stable and there is no rebound tenderness. Computed tomography (CT) shows dilated small bowel loops terminating at a thick-walled terminal ileum without pneumatosis.Nasogastric tube decompression, intravenous fluids, and systemic corticosteroids
- A -year-old woman with a history of severe peripheral arterial disease and chronic postprandial abdominal pain presents with acute worsening of her pain. She is hemodynamically stable and the abdomen is soft and non-tender.CT angiography of the abdomen and pelvis
- A -year-old man, currently intubated in the intensive care unit for severe sepsis secondary to pneumonia, develops a new fever and right upper quadrant mass. Ultrasound reveals a distended, thick-walled gallbladder with pericholecystic fluid but no stones.Placement of a percutaneous cholecystostomy tube
- A -year-old man with a history of recurrent uncomplicated diverticulitis presents with the sudden onset of diffuse, severe abdominal pain. He is hypotensive and tachycardic, with a rigid abdomen and generalized guarding.Aggressive fluid resuscitation and emergent exploratory laparotomy
- A -year-old woman at weeks gestation presents with acute right-sided abdominal pain and leukocytosis. A graded compression ultrasound of the right lower quadrant is non-diagnostic due to the gravid uterus.Magnetic resonance imaging (MRI) of the abdomen and pelvis
Answer
The correct pairings match each specific acute abdominal presentation to its standard-of-care next step, distinguishing between operative, non-operative, and imaging-first pathways based on clinical stability, patient population (e.g., pregnancy, ICU), and diagnostic findings.
Acute abdominal emergencies present uniquely in special populations and require nuanced triage. Crohn disease strictures often require medical management (steroids) rather than surgery to preserve bowel length. Critically ill ICU patients with acalculous cholecystitis need percutaneous drainage as they cannot tolerate general anesthesia. Pregnant patients require radiation-sparing MRI when ultrasound fails. Acute-on-chronic ischemia without peritonitis mandates CTA to plan revascularization. Conversely, any patient with generalized peritonitis and hemodynamic instability (such as perforated diverticulitis) requires immediate emergent laparotomy regardless of other factors.
Step-by-Step Solution
Key Concept
The management of acute abdominal pathologies must be tailored to the patient's specific clinical context, utilizing conservative medical therapy for inflammatory strictures, specialized imaging for vascular or pregnant patients, temporizing drainage in critically ill patients, and emergent laparotomy for generalized peritonitis.
Estimated Time:2m 30s