Intended for healthcare professionals

Endgames OnExamination Quiz

Acute abdomen

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4803 (Published 19 November 2009) Cite this as: BMJ 2009;339:b4803

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Presentation 1

A 50 year old woman presents with a five day history of right upper quadrant pain. The pain has become constant and is associated with nausea. She has fever and tenderness in the right upper quadrant.

Presentation 2

A 90 year old patient develops acute distension of the abdomen. He has a dense hemiplegia from a stroke two weeks previously. He is confused. His abdomen is grossly distended and he has not passed a stool or flatus for two days. A plain abdominal x ray shows dilated loops of large bowel.

Presentation 3

A 35 year old woman has an appendicectomy for perforated appendicitis. Ten days later she becomes unwell with a swinging fever and a high white blood cell count.

Presentation 4

Three days after a right hemicolectomy for carcinoma of the caecum, a 68 year old patient begins vomiting and has abdominal distension. The abdomen is not tender and there are no bowel sounds. Passage of a nasogastric tube produces large volumes of aspirate.

Presentation 5

An 18 year old motorcyclist is brought to the accident and emergency department after being hit by a car. He has a tachycardia and hypotension. Abdominal examination shows left upper quadrant tenderness. A diagnostic peritoneal lavage is performed. The aspirate is blood stained.

For each of the above presentations, select the single most likely diagnosis. Each option may be used once, more than once, or not at all.

  • A Perforated viscus

  • B Acute appendicitis

  • C Biliary peritonitis

  • D Ruptured spleen

  • E Pelvic abscess

  • F Paralytic ileus

  • G Colonic pseudo-obstruction

  • H Large bowel obstruction

  • I Small bowel obstruction

  • J Acute cholecystitis

Notes

Cite this as: BMJ 2009;339:b4803

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