Match each clinical presentation of acute abdominal pain to the most appropriate next step in management.
- A 24-year-old man presents with low-grade fever, anorexia, and progressive right lower quadrant pain with focal rebound tenderness.Prompt appendectomy
- A 55-year-old woman with a history of hysterectomy presents with crampy, intermittent abdominal pain, bilious emesis, and high-pitched bowel sounds. She is hemodynamically stable with no localized tenderness.Nasogastric decompression, intravenous fluids, and close observation
- A 71-year-old man with chronic atrial fibrillation presents with sudden-onset, severe abdominal pain that is out of proportion to his relatively benign physical examination.CT angiography of the abdomen and pelvis
- A 48-year-old man with a history of chronic NSAID use presents with sudden, severe epigastric pain. Examination reveals a rigid, board-like abdomen and diffuse peritonitis.Emergent exploratory laparotomy
Cevap
The correct matches pair acute appendicitis with prompt appendectomy, uncomplicated small bowel obstruction with conservative management, early acute mesenteric ischemia with CT angiography, and perforated viscus with emergent laparotomy.
Each presentation maps to a distinct pathway in the management of the acute abdomen. Acute appendicitis with typical findings is a clinical diagnosis warranting prompt appendectomy. Uncomplicated SBO without peritonitis should be managed conservatively first. Acute mesenteric ischemia classically presents with pain out of proportion to exam and requires rapid diagnosis with CT angiography. A perforated viscus with diffuse peritonitis is a surgical emergency necessitating immediate laparotomy.
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Anahtar Kavram
Triage and initial management of the acute surgical abdomen based on clinical presentation and presence of peritonitis.