abdominal pain

A 3-year-old boy presents with sudden onset intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is pale and has a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). Based on this finding, what is the most appropriate next step in management?

A 68-year-old male presents with abdominal distension, obstipation, and vomiting. He has a history of prior abdominal surgery. An upright abdominal X-ray is performed. What is the MOST appropriate next step in management?

A 3-year-old boy presents with sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. On examination, he is pale and has a palpable mass in the right upper quadrant. Vitals are stable. An ultrasound is performed, shown above. Based on the clinical presentation and the provided image, what is the most appropriate next step in the management of this patient?

A 45-year-old male with Crohn's presents with persistent right lower quadrant pain. Stool studies are negative. Review the imaging. What is the MOST likely complication?

A 64-year-old woman presents for review in the outpatient clinic. She reports a history of intermittent, self-resolving episodes of right upper quadrant colicky pain over the past year, but is currently asymptomatic. She denies fever, jaundice, or other systemic symptoms. Her physical examination is unremarkable, and recent liver function tests are within the normal reference range. An elective abdominal ultrasound was performed, yielding the image shown. Based on the clinical presentation and the findings demonstrated, what is the most appropriate next step in her management?

A 35-year-old male with a history of multiple cutaneous vascular lesions presents with recurrent episodes of crampy abdominal pain and melena over the past month. His vital signs are stable. An abdominal CT scan is performed. Considering the clinical presentation and the findings demonstrated in the provided image, what is the most likely underlying pathology responsible for the patient's symptoms and the observed bowel findings?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). The provided image was obtained as part of his staging workup. Which of the following is the MOST appropriate next step in management?

A 63-year-old woman with a 20-year history of Crohn's disease presents with a one-month history of worsening abdominal pain, bloating, and occasional vomiting, associated with a 3kg weight loss. She is currently managed with mesalazine and azathioprine. Her vital signs are stable, and physical examination reveals mild right lower quadrant tenderness. Imaging is performed. Considering the clinical presentation and the provided images, which of the following represents the most appropriate next step in this patient's management?

A 58-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and RUQ pain. His AFP is markedly elevated. A CT abdomen with IV contrast is performed, as shown. What is the MOST appropriate next step in confirming the suspected diagnosis?

A 55-year-old man with a history of renal transplant on immunosuppression presents with a 2-week history of low-grade fever, malaise, and dull right upper quadrant discomfort. Physical examination is unremarkable except for mild tenderness on deep palpation of the right upper quadrant. Blood tests show a mild leucocytosis and elevated CRP. Imaging is performed. Based on the clinical presentation and imaging findings, what is the most appropriate next diagnostic step?

A 62-year-old man, post-renal transplant, presents with RUQ pain and fever. Imaging is shown. What is the MOST appropriate next step in management?

A 63-year-old man presents with increasing postprandial fullness. The provided image was obtained. What is the MOST appropriate next step in management?

A 55-year-old female presents to the emergency department with a 24-hour history of severe right upper quadrant pain radiating to the back, associated with nausea, vomiting, and subjective fever. On examination, she is tachycardic (HR 105 bpm) and febrile (38.5°C), with marked tenderness and guarding in the right upper quadrant. Blood tests reveal a white cell count of 15 x 10^9/L and C-reactive protein of 120 mg/L. Liver function tests, including bilirubin, are within normal limits. She is initiated on intravenous fluids and broad-spectrum antibiotics. Imaging is obtained. Considering the patient's clinical status and the findings on the provided imaging, which of the following represents the most appropriate definitive management strategy?

A 55-year-old patient with a history of solid organ transplant on immunosuppressive therapy presents with a 2-week history of low-grade fever, malaise, and dull right upper quadrant discomfort. Physical examination is unremarkable except for mild tenderness in the right upper quadrant. Blood tests reveal a CRP of 85 mg/L (normal <5), WCC 11.5 x 10^9/L (normal 4-11), and mildly elevated alkaline phosphatase. Imaging is performed as shown. What is the most appropriate next step in management?

A 78-year-old male presents to the emergency department with a 6-hour history of sudden onset, severe pain and swelling in his right groin. He reports nausea but no vomiting. On examination, there is a tender, firm, non-reducible lump in the right inguinal region. Bowel sounds are present. Vitals are stable: BP 130/80, HR 75, Temp 36.8°C. A CT scan of the pelvis is performed, shown in the image. Based on the clinical presentation and the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?

A 64-year-old woman presents with a history of intermittent RUQ pain. She denies jaundice or fever. An abdominal ultrasound was performed, as shown. What is the MOST appropriate next step in management?

A 45-year-old woman presents to the ED with right upper quadrant pain, fever, and nausea for 24 hours. Her vital signs are: HR 105 bpm, BP 130/80 mmHg, Temp 38.5°C. Physical exam reveals marked tenderness on palpation of the right upper quadrant. An abdominal CT scan is performed, as shown. What is the MOST appropriate next step in management?

A 65-year-old man presents with 2 days of left lower quadrant abdominal pain, fever, and nausea. On examination, he is afebrile, haemodynamically stable, with localised tenderness in the LLQ. Blood tests show a WCC of 14.5. A CT scan of the abdomen and pelvis is performed. Considering the clinical presentation and the findings demonstrated in the image, what is the most appropriate initial management plan?

A 3-week-old male infant presents with persistent, non-bilious projectile vomiting after each feed. He appears hungry and eagerly accepts the bottle, but vomits shortly after. On examination, mild dehydration is noted. An abdominal X-ray is ordered, the relevant image is attached. What is the MOST appropriate next step in management?

A 58-year-old male presents to the emergency department complaining of right groin pain that started approximately 6 hours ago. He reports noticing a bulge in his groin for several months, which he could usually push back in. However, today he is unable to reduce it, and the pain has become progressively severe. He denies any fever, nausea, or vomiting. His past medical history includes hypertension and hyperlipidemia, both well-controlled with medications. On examination, his vital signs are stable: blood pressure 130/80 mmHg, heart rate 80 bpm, respiratory rate 16 bpm, and temperature 37.0°C. Abdominal examination is benign. Examination of the groin reveals the finding shown in the image. The area is tender to palpation. Which of the following is the MOST appropriate next step in the management of this patient?

A neonate is born at term following an uneventful pregnancy. Immediately after birth, the baby develops bilious vomiting. Abdominal examination reveals epigastric distension, but the rest of the abdomen is scaphoid. An abdominal X-ray is performed. Which of the following findings on the abdominal X-ray would be most consistent with the likely diagnosis?

A 75-year-old male with a history of a reducible groin hernia presents with acute abdominal pain. The provided image was taken. What is the most likely complication?

A 28-year-old female presents to the ED with acute onset right lower quadrant pain. She reports nausea and vomiting. Her last menstrual period was 6 weeks ago, and she denies any vaginal bleeding. She is hemodynamically stable. A CT scan of the abdomen and pelvis is performed, with a relevant image shown. What is the MOST appropriate next step in the management of this patient?

A 52-year-old female presents with right upper quadrant pain, fever, and leukocytosis. The image shows the likely cause. What is the MOST appropriate initial management?

A 62-year-old male presents with a 3-month history of worsening upper abdominal pain, significant fatigue, and a 10 kg unintentional weight loss. His medical history includes long-standing peptic ulcer disease managed with proton pump inhibitors. On examination, he has mild hepatomegaly and trace ascites. Initial blood tests show elevated alkaline phosphatase and gamma-glutamyl transferase, with normal serum bilirubin and transaminases. A contrast-enhanced CT scan of the abdomen and pelvis is performed, and representative images are provided. Considering the clinical presentation and the findings demonstrated on the imaging, which of the following represents the MOST appropriate immediate next step in the management of this patient?

A 68-year-old male presents to the ED with a painful lump in his groin that has been present for 3 days. He reports nausea but denies vomiting. His vital signs are stable. An abdominal CT is performed, and a slice is shown. What is the MOST appropriate next step in management?

A 45-year-old male presents to the ED with left flank pain radiating to his groin. He reports nausea but no vomiting. Vitals are stable. A focused ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A 62-year-old male presents with left lower quadrant pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed (image attached). Assuming the diagnosis, which of the following is the MOST appropriate initial management?

A 58-year-old male presents with acute onset LLQ pain, low-grade fever, and mild nausea. His vitals are stable. An abdominal CT scan was performed, the axial view is shown. What is the MOST appropriate initial management strategy?

A 28-year-old female presents to her general practitioner with a 6-month history of intermittent abdominal pain, predominantly in the right lower quadrant. She describes the pain as cramping and associated with occasional episodes of non-bloody diarrhea. She denies fever, weight loss, or recent travel. Her past medical history is significant for well-controlled asthma, for which she uses an inhaled corticosteroid as needed. Physical examination reveals mild tenderness to palpation in the right lower quadrant, but is otherwise unremarkable. Bowel sounds are normal. Initial laboratory investigations, including a complete blood count and comprehensive metabolic panel, are within normal limits. Stool studies for ova and parasites, bacterial culture, and Clostridium difficile toxin are negative. Given her persistent symptoms, the GP refers her for further evaluation. A CT enterography is performed, and relevant images are shown. Based on the clinical presentation and imaging findings, which of the following is the MOST likely long-term complication this patient is at increased risk of developing?

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is elevated. A CT scan of the abdomen with and without contrast is performed, as shown. What is the MOST appropriate next step in management?

A 28-year-old female presents with sudden onset severe right lower quadrant pain, associated with nausea and one episode of vomiting. Her last menstrual period was 6 weeks ago. On examination, she is afebrile, heart rate 88, blood pressure 120/70. Abdominal examination reveals tenderness in the right iliac fossa. A CT scan of the abdomen and pelvis is performed, with a relevant axial image shown. Considering the clinical presentation and the findings demonstrated in the image, what is the MOST appropriate immediate next step in the management of this patient?

A 28-year-old woman presents to the emergency department with sudden onset of severe right lower abdominal pain. She reports nausea but no vomiting. Her last menstrual period was two weeks ago, and she is not sexually active. On examination, she has tenderness in the right lower quadrant with guarding. Her vital signs are stable. A pelvic ultrasound shows a 5 cm cyst on the right ovary with free fluid in the pelvis. What is the most likely diagnosis?

A 25-year-old woman presents to the clinic with a 2-week history of abdominal pain and diarrhea. She reports that the pain is crampy and occurs mostly in the lower abdomen. She has also noticed some blood in her stool. She has no significant past medical history and is not on any medications. On examination, she has mild tenderness in the lower abdomen but no rebound tenderness or guarding. What is the most likely diagnosis?

A 48-year-old man with multiple cutaneous hemangiomas presents with crampy abdominal pain and guaiac-positive stools. The provided image was obtained. What is the MOST appropriate initial diagnostic test to identify the source of bleeding?

A 35-year-old man presents to the emergency department with severe right-sided flank pain that started suddenly and radiates to the groin. He describes the pain as sharp and colicky. He has had similar episodes in the past but never this severe. He denies fever, dysuria, or hematuria. On examination, he is in obvious distress, with a blood pressure of 140/90 mmHg, heart rate of 110 bpm, and respiratory rate of 22 breaths per minute. Abdominal examination reveals tenderness in the right flank but no guarding or rebound tenderness. Urinalysis shows microscopic hematuria. Which of the following is the most appropriate initial imaging study to confirm the diagnosis?

A 4-week-old male presents with persistent projectile vomiting after feeding. He is otherwise well-appearing. An upper GI series is performed, with relevant images attached. What acid-base disturbance is MOST likely present?

A 45-year-old woman presents to her general practitioner with a 6-month history of intermittent diarrhea, abdominal pain, and weight loss. She reports that her symptoms are exacerbated by stress and certain foods, particularly those containing gluten. She has a family history of autoimmune thyroid disease. On examination, she appears pale and has a slightly distended abdomen with mild tenderness in the lower quadrants. Laboratory tests reveal microcytic anemia and elevated tissue transglutaminase antibodies. Which of the following is the most appropriate next step in the management of this patient?

A 75-year-old female presents to the emergency department with a 24-hour history of worsening colicky abdominal pain, nausea, and multiple episodes of bilious vomiting. She reports no passage of flatus or stool for the past 18 hours. Her past medical history includes an open appendectomy 30 years ago and a hysterectomy 10 years ago. On examination, she is afebrile, heart rate 92 bpm, blood pressure 130/80 mmHg, respiratory rate 18/min, oxygen saturation 98% on room air. Her abdomen is distended and diffusely tender to palpation, with high-pitched tinkling bowel sounds on auscultation. A plain abdominal X-ray series, including the image provided, was obtained. Given the clinical presentation and the findings demonstrated in the provided image, which of the following is the most appropriate *next* investigation to guide definitive management?

A previously healthy 2-year-old boy presents to the emergency department with a 1-day history of colicky abdominal pain. His parents report that the pain occurs in episodes, during which he cries intensely and pulls his legs up to his chest. Between episodes, he appears relatively comfortable. He has had one episode of vomiting. His parents also noticed a small amount of blood in his stool this morning. On examination, the child is alert but irritable. His abdomen is soft, but a palpable mass is noted in the right upper quadrant. An ultrasound is performed, with a representative image shown. What is the MOST appropriate initial management strategy?

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Based on the clinical presentation and the provided image, if outpatient management is deemed appropriate, which of the following antibiotic regimens is most consistent with current Australian guidelines?

A 55-year-old male presents with LLQ pain, fever, and increased WBC. A CT scan is performed, as shown. He is hemodynamically stable. What is the MOST appropriate initial management?

A 65-year-old male presents with 2 days of constant right upper quadrant pain radiating to the back, associated with nausea and subjective fever. On examination, he is febrile (38.5°C) with significant tenderness and a positive Murphy's sign in the right upper quadrant. His white cell count is elevated at 15 x 10^9/L, and CRP is 120 mg/L. Liver function tests are within normal limits. Considering the clinical presentation and the provided imaging, what is the most appropriate timing for definitive surgical management?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history is significant for a recently diagnosed gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?

A 32-year-old woman presents to the emergency department with severe right lower quadrant abdominal pain, nausea, and vomiting. She reports her last menstrual period was 6 weeks ago. On examination, she has tenderness and guarding in the right lower quadrant. A urine pregnancy test is positive. What is the most appropriate next step in management?

A 32-year-old woman presents with pelvic pain and bloating. Her periods are regular. An abdominal CT scan is performed. Based on the image, what is the MOST appropriate next step in management?

A 68-year-old man presents with 3 days of worsening left lower quadrant pain, fever, and nausea. He has a history of diverticulosis. On examination, he is tachycardic (HR 105), afebrile (37.5°C), and has localised tenderness with guarding in the left iliac fossa. His blood tests show a WCC of 16 x 10^9/L and CRP 150 mg/L. He is commenced on intravenous antibiotics. A CT scan is performed (image provided). Considering the clinical context and the findings on the image, what is the most appropriate next step in management?

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with fever (38.2°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His blood pressure is 130/80 mmHg, heart rate 85 bpm, respiratory rate 16 bpm. Blood tests show a white cell count of 14 x 10^9/L and CRP 80 mg/L. A CT scan of the abdomen and pelvis is performed (image provided). Considering the patient's presentation and the findings on the provided image, which of the following is the most appropriate initial management strategy?

A 42-year-old male presents to the emergency department with a 3-day history of colicky abdominal pain, nausea, and vomiting. He reports that he has not had a bowel movement in 2 days and has noticed some blood in his vomit. He has a known history of multiple cutaneous hemangiomas since childhood. On examination, his abdomen is distended and tympanic, with tenderness to palpation in all quadrants. Bowel sounds are high-pitched and infrequent. Vitals are stable. A CT scan of the abdomen and pelvis is performed, and a representative image is shown. What is the MOST likely underlying cause of the patient's acute presentation, considering his history and the imaging findings?

A 3-year-old boy presents with inconsolable crying and drawing up his legs. Stool sample is positive for blood. The ultrasound is shown. What is the next step?