Abdominal and Pelvic
Pain
Answers
74.The answer is d.(Rosen, pp 1288-1293.)There is a high suspicion that
this patient has mesenteric ischemia,secondary to a thromboembolism
from her atrial fibrillation.The typical patient with mesenteric ischemia
may initially present with “pain that is out of proportion to the examination”
(ie, although the patient is in pain, the abdomen is neither rigid, nor signif-
icantly tender on physical examination). Abdominal distention and peri-
toneal signs are late findings and signal the presence of bowel infarction.
Plain abdominal radiographs are usually obtained early on in the workup.
Although rare, the finding of gas in either the bowel wall (pneumatosis
intestinalis)or in the portal venous system is strongly suggestive of intesti-
nal infarct. This is a surgical emergency!
(a, b, c, and e)These are possible findings on radiography for patients
with bowel infarction, although less sensitive and specific for infarction
compared to pneumatosis intestinalis.
75.The answer is b.(Rosen, pp 1301-1318.)Viral diarrhealdiseases are
responsible for the majority of all acute episodes of diarrhea. Rotavirus,typ-
ically a disease of young children and Norwalk virusare the most frequent
etiologic agents. In addition, enteric adenovirus is a common cause of gas-
troenteritis. Though dehydration is a common complication, these illnesses
are usually self-limited, requiring only supportive care.
(c, d, and e)Bacterial causes of diarrheal disease comprise approxi-
mately 20% of all cases. (a)Parasitic causes are much more common outside
of the United States.
76.The answer is d.(Tintinalli, pp 508-511.)Foreign bodies tend to lodge
or impact at sites where esophageal narrowing occurs. In the adult, the
lower esophageal sphincteris the most common site for impactions.
When impaction occurs, patients usually feel some discomfort, sometimes
substernal chest pain, anxiety, and progressive dysphagia. Most of the time,
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