12-29-2010, 05:57 PM
A 77-year-old man presents to the emergency department (ED) in the early morning with a 4-hour history of severe, generalized abdominal pain. He describes some “cramp-like” abdominal pain and bilious vomiting yesterday, but states he simply “got on with things”. His condition had worsened considerably by late evening. He describes the sudden onset of generalized, constant, intense abdominal pain necessitating an ambulance call. On presentation to the ED, he has no current vomiting. He complains of episodic “indigestion” that has occurred off and on for the past few months. On further questioning, the patient reports experiencing infrequent but quite painful episodes of upper abdominal pain and is associated with intermittent vomiting. This lasts for minutes to hours after the intake of meals. He states that antacid preparations do little good in controlling these symptoms, but he takes them anyway. His past medical history includes hypertension and ischemic heart disease.On examination, the patient looks like dehydrated.His heart rate is 80 bpm, his blood pressure is 102/65 mm Hg, his capillary refill time is prolonged, and cool extremities are noted. He is afebrile. His lungs are clear to auscultation and his heart sounds are normal, with no added sounds. His abdomen is mildly distended. When asked to cough, the patient winces in pain. Palpation of the abdomen reveals generalized, diffuse tenderness and board-like rigidity. The abdomen is tender to percussion throughout all 4 quadrants, with a tympanic note that is associated with loss of liver dullness. Erect chest and supine abdominal radiographs are obtained which shows the presence of a large amount of free intraperitoneal air and dilated loops of small bowel . A nasogastric tube is inserted and instructions are given for the patient to remain ‘nil by mouth'
What is the likely pathology responsible for this patient’s current problems?
A.Cholelithiasis
B.Peptic ulcer disease
C.Intestinal adhesions
D.Chronic pancreatitis
E.Mesenteric Ischaemia
What is the likely pathology responsible for this patient’s current problems?
A.Cholelithiasis
B.Peptic ulcer disease
C.Intestinal adhesions
D.Chronic pancreatitis
E.Mesenteric Ischaemia