Pain in abdomen

A 57-year-old woman presents with a mild left lower abdominal pain that becomes gradually more severe and diffuse. She said pain is associated with nausea and constipation. On abdominal examination, the abdomen is distended with diffuse tenderness, rebound tenderness and absent bowel sounds. Which of the following is the most likely diagnosis?

• Burst appendix with pelvic peritonitis

• Perforated sigmoid diverticular abscess with peritonitis

• Sigmoid volvulus

• Toxic megacolon

A 35-year-old man presents abdominal pain following blunt abdominal trauma 12 hours ago. The pain is constant pain with 6/10 in severity. His vital signs are stable and mild pallor was noted. CECT (abdomen) revealed peri splenic hematoma with G II splenic injury. Which of the following treatment is most suitable for this paitent?

• Splenectomy

• Watchful waiting

• Splenorraphy

• Arterial embolization

A 65-year-old woman was brought to ER with history of sudden onset of upper abdominal region in the last 6 hours. Later the became more severe 10/10 and radiated to the whole abdomen. Her urine output was decreased since then and she felt dizziness. She was on NSAID for 2 months for her osteoarthritis of knee. Which of the following clinical sign is most possible to be found in this patient?

• Succussion splash on examination

• Visible peristalsis

• Increased bowel sounds

• Guarding and rigidity

A 48-year-old woman presents with a mild left lower abdominal pain that becomes gradually more severe and diffuse. She said pain is associated with nausea and constipation. On abdominal examination, the abdomen is distended with diffuse tenderness, rebound tenderness and absent bowel sounds. Abdominal CT scan shows pericolic and pelvic abscesses with Hinchey Grade II. What is the possible diagnosis?

• Perforated appendicitis

• Peptic ulcer perforation

• Colonic diverticular perforation

• Intestinal obstruction

A 66-year-old chronic case of cirrhosis of liver with hepatitis B infection presents with pain in the whole abdomen for 3 hours. The pain started at right hypochondrium and radiate to the whole abdomen. The pain score was 10/10. On examination, rigid and tender abdomen was noted. His vital signs are unstable and marked pallor and icteric conjunctiva were also noted. Bowel is absent. Which of the following investigation is most suitable to get the diagnosis?

• X-ray abdomen

• ERCP

• PET CT

• CECT

A 50-year-old chronic smoker male presents with severe pain in the whole abdomen for 1 hour. He has preceding 6-year-history of central abdominal pain with pulsatile mass, for which he has plan to undergo elective major operation. On examination, shock with marked pallor is noted and he is confused. His abdominal examination revealed generalised peritonitis with absent bowel sound. Your consultant decided to do emergency operation. His family and patient wanted to know the operative mortality rate. Which of the following is will be the maximum operative mortality rate?

• 70%

• 35%

• 15%

• 5%

A 46-year-old man presented with history of sudden onset of constant epigastric pain radiating to the back with nausea. There is central and upper abdominal tenderness. The serum amylase is 1642 IU. Which of the following is suitable for local severity staging of this condition?

• BISAP

• Ranson scoring

• Glasgow

• Balthazar

A 48-year-old female presented with left lower abdominal pain for 4 days. Her symptoms were getting worse with vomiting and severe pain. She has chronic constipation. She looks dyspnoeic and is haemodynamically unstable. Physical examination showed massive abdominal distension, rigidity and tenderness. A plain radiograph demonstrates a dilated sigmoid with free intraperitoneal gas. What is the most suitable next step in management for this patient?

• Emergency laparotomy, resection of volvulus with colostomy

• Emergency laparotomy, resection of volvulus with anastomosis

• Open detorsion and mesenteric plication

• Trans-anal deflation of volvulus by rigid sigmoidoscopy

Appendectomy is the treatment of choice for acute appendicitis in infants because:

• Appendicular blood supply is poor

• Greater omentum is underdeveloped

• Appendix is most commonly pelvic in position

• Appendix is elongated

A 48-year-old woman, victim of motor vehicle accident, presents with pain in the left upper quadrant of the abdomen. Patient has bruises over the left upper quadrant, which is tender on palpation. Bowel sound is sluggish and shifting dullness is noted. Her vital signs are unstable. Which of the following is the most appropriate investigation in this case?

• Plain abdominal radiography

• Diagnostic laparoscopy

• Diagnostic peritoneal lavage

• FAST scan