are the major symptoms. The illness is self-limited and rarely lasts for more
than 24 hours. (d)Campylobacter is the most common bacterial cause of
diarrhea in patients who seek medical attention. The incubation period is
approximately 2 to 5 days. Onset of symptoms is usually rapid and consists
of fever, crampy abdominal pain, and diarrhea. Constitutional symptoms are
common.(e)Salmonellosis occurs most during the summer months and is
acquired by the ingestion of contaminated food or drink. Poultry products,
such as turkey, chicken, duck, and eggs constitute the most common
sources. Family outbreaks and sporadic cases are more common than large
epidemics. The typical patient presents with fever, colicky abdominal pain,
and loose, watery diarrhea, occasionally with mucus and blood. Symptoms
usually abate within 2 to 5 days and recovery is uneventful.
113.The answer is b.(Rosen, pp 1288-1291.)Acute mesenteric ischemia
is caused by the lack of perfusion to the bowel. It primarily affects patients over
the age of 50 years,particularly those with significant cardiovascular or sys-
temic disease. The etiology is either from arterial occlusion (eg, embolization
from the heart); venous thrombosis that is associated with a hypercoagulable
state; or nonocclusive, because of reduced cardiac output (eg, congestive heart
failure [CHF], recent myocardial infraction [MI], hypovolemia). Most patients
present with abdominal pain that is initially dull and diffuse. In this early state,
patients frequently complain of severe pain, but have minimal tenderness on
examination (ie, the characteristic “pain out of proportion to examination”).
As infarction develops, abdominal distension and peritoneal signs develop.
Sudden onset of pain suggests arterial vascular occlusion by emboli. This may
occur with patients who present in atrial fibrillation.Insidious onset suggests
venous thrombosis or nonocclusive infarction. Radiographs may reveal dilated
loops of bowel, air in the bowel wall (“pneumatosis intestinalis”), and thick-
ening of the bowel wall, as seen in the CT scan. Management involves fluid
resuscitation, antibiotics, and surgical intervention.
(a)Classically, AAA present with constant abdominal pain, often local-
izing to the left middle or lower quadrant, with radiation to the back. Phys-
ical examination may reveal a pulsatile abdominal mass. (c)Diverticulitis
usually presents with LLQ abdominal pain and low-grade fever. (d)Patients
with a SBO present with crampy abdominal pain and distention. Vomiting
and obstipation are frequent symptoms. Distended loops of bowel and air-
fluid levels are seen on radiographs. (e)Crohn disease may present with
bloody diarrhea, abdominal pain, fevers, anorexia, and weight loss. There is
a peak incidence between 15 and 22 years and 55 and 60 years.
Abdominal and Pelvic Pain Answers 123