abdominal pain

A 62-year-old male with a history of poorly controlled diabetes presents with right upper quadrant pain, fever, and night sweats for 3 weeks. He is on immunosuppressants following a renal transplant 5 years ago. Blood cultures are pending. Imaging is performed, as shown. What 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 55-year-old patient with a history of solid organ transplant on immunosuppressive therapy presents with a two-week history of intermittent fever, chills, and dull right upper quadrant pain. On examination, there is mild tenderness in the right upper quadrant. Blood tests reveal a white cell count of 14 x 10^9/L and CRP of 120 mg/L. Imaging is performed. Considering the clinical context and the provided images, what is the most appropriate immediate next step in the management of this patient?

A 55-year-old woman presents with 2 days of worsening right upper quadrant pain radiating to her back, nausea, and subjective fever. On examination, she is tender in the RUQ. Vitals are stable. Labs show WCC 15.0, CRP 120. This image is obtained. Given the clinical context and imaging findings, what is the most appropriate definitive management strategy?

A 68-year-old man presents to the emergency department with a 2-day history of worsening left lower quadrant abdominal pain, associated with subjective fever, chills, and nausea. He reports some recent constipation. On examination, his temperature is 38.5°C, pulse 95 bpm, BP 130/80 mmHg. Abdominal examination reveals tenderness and guarding in the left iliac fossa. Bowel sounds are reduced. Blood tests show a white cell count of 15 x 10^9/L (neutrophils 85%) and C-reactive protein of 120 mg/L. Urea, electrolytes, and creatinine are within normal limits. A CT scan of the abdomen and pelvis is performed (image provided). Considering the clinical presentation and the findings demonstrated in the provided image, which of the following represents the most appropriate initial management strategy?

A 45-year-old woman presents to the emergency department with severe right upper quadrant abdominal pain that started suddenly 3 hours ago. She describes the pain as sharp and radiating to her right shoulder. She has a history of gallstones but has never had surgery. On examination, she is febrile with a temperature of 38.5°C, her blood pressure is 110/70 mmHg, and her heart rate is 100 bpm. She has tenderness in the right upper quadrant with a positive Murphy's sign. Laboratory tests reveal leukocytosis and mildly elevated liver enzymes. An abdominal ultrasound shows gallstones and a thickened gallbladder wall with pericholecystic fluid. What is the most appropriate next step in the management of this patient?

A 62-year-old male presents to the emergency department complaining of left lower quadrant abdominal pain for the past three days. He describes the pain as constant and sharp, rating it an 8 out of 10. He also reports nausea, decreased appetite, and subjective fevers. His past medical history is significant for hypertension and hyperlipidemia, both well-controlled with medications. He denies any recent travel or sick contacts. On physical examination, his abdomen is tender to palpation in the left lower quadrant with guarding. Bowel sounds are present but diminished. The remainder of his examination is unremarkable. His vital signs are: Temperature 38.2°C, Heart Rate 98 bpm, Blood Pressure 140/90 mmHg, Respiratory Rate 18 breaths per minute, and Oxygen Saturation 98% on room air. Laboratory results show a white blood cell count of 14,000/µL with a neutrophilic predominance. A CT scan of the abdomen and pelvis with intravenous contrast is performed, and a representative image is shown. Assuming the patient has no allergies, what is the MOST appropriate initial management strategy?

A 68-year-old woman presents to the emergency department with right upper quadrant abdominal pain, fever, and jaundice. Her vital signs are: temperature 38.5°C, heart rate 110 bpm, blood pressure 110/70 mmHg, respiratory rate 20 breaths per minute, and oxygen saturation 97% on room air. Initial laboratory investigations reveal: white blood cell count 14,000/µL, total bilirubin 6.0 mg/dL, alkaline phosphatase 450 U/L, ALT 300 U/L, and AST 250 U/L. An ERCP is performed, and the image is obtained. Following successful intervention, what is the MOST appropriate next step in managing this patient's condition?

A 62-year-old male presents to his general practitioner complaining of a dragging sensation in his right groin, particularly noticeable when standing for prolonged periods or straining during bowel movements. He denies any acute pain, nausea, vomiting, or changes in bowel habits. His past medical history is significant for benign prostatic hyperplasia (BPH) managed with tamsulosin. On examination, the patient is afebrile with normal vital signs. Palpation of the abdomen is unremarkable. Examination of the groin reveals the finding shown in the image. The swelling increases with coughing. Which of the following is the MOST appropriate next step in the management of this patient?

A 63-year-old woman with a 20-year history of Crohn's disease presents with worsening abdominal pain, bloating, and occasional post-prandial vomiting. She is currently managed with mesalazine and budesonide. Physical examination reveals mild right lower quadrant tenderness. Laboratory tests show a slightly elevated CRP. Given her presentation and the provided imaging, what is the most appropriate next step in her management?

A 72-year-old man with a history of cholelithiasis presents with a 2-day history of fever, jaundice, and severe right upper quadrant pain. His vital signs are stable, but laboratory tests show elevated bilirubin and alkaline phosphatase. He is undergoing urgent ERCP for management of suspected choledocholithiasis and cholangitis. Following successful cannulation and injection of contrast, the image is obtained. Considering the findings demonstrated in the image in the context of this patient's presentation, what is the most appropriate immediate next step during this procedure?

A 68-year-old male presents with a 2-day history of worsening left lower quadrant abdominal pain, fever (38.5°C), and nausea. He has a history of similar, milder pain episodes. Examination reveals left iliac fossa tenderness with guarding. Bloods show WCC 16, CRP 120. A CT scan is performed (image provided). Considering the clinical picture and the imaging findings, which of the following represents the most appropriate initial management strategy?

A 2-week-old baby is brought to the clinic with abdominal distension and bilious vomiting. On examination, the abdomen is tense and tender. What is the most likely diagnosis?

A 68-year-old male presents with constant RUQ pain for 3 days. The image was obtained. What is the MOST likely complication if definitive management is delayed?

A 4-year-old presents with abdominal distension and back pain for 2 months. Exam reveals a firm, fixed abdominal mass. Vitals are normal. An abdominal CT is performed (axial view shown). Which lab finding would MOST strongly support the suspected diagnosis?

A 32-year-old woman presents to the ED with acute lower abdominal pain. She reports nausea but denies fever or vaginal bleeding. Her last menstrual period was 3 weeks ago. A CT scan of the abdomen and pelvis is performed, the relevant image is shown. What 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 colicky abdominal pain, bloating, and occasional non-bilious vomiting, associated with a 3kg weight loss. She reports reduced stool frequency. She is currently managed with mesalazine and azathioprine. Her vital signs are stable (BP 120/75, HR 82, Temp 36.8), and physical examination reveals mild right lower quadrant tenderness without guarding or rebound. Bowel sounds are hyperactive. Imaging is performed. Considering the clinical presentation, her current therapy, and the findings suggested by the provided images, which of the following represents the most appropriate next step in this patient's management?

A 59-year-old male presents with a painful right groin bulge that has progressively worsened over the past week. He denies fever, chills, nausea, or vomiting. Vitals are stable. The provided image was obtained. What is the MOST appropriate next step?

A 28-year-old male with Crohn's presents with increased abdominal pain, non-bloody diarrhea, and fatigue for 3 weeks. He denies fever. Exam shows mild RLQ tenderness. Labs show elevated CRP. Imaging is shown. What is the MOST appropriate next step?

A 32-year-old male presents to the emergency department with a 3-day history of worsening abdominal pain, primarily localized to the right lower quadrant. He reports associated nausea and decreased appetite but denies vomiting or diarrhea. His past medical history is significant for Crohn's disease, diagnosed 8 years ago, managed with intermittent courses of oral corticosteroids and azathioprine. He admits to poor adherence to his azathioprine regimen over the past year. On examination, he is afebrile with a heart rate of 92 bpm, blood pressure of 120/80 mmHg, and oxygen saturation of 98% on room air. Abdominal examination reveals tenderness to palpation in the right lower quadrant with guarding. Bowel sounds are normoactive. Laboratory investigations reveal a white blood cell count of 11,500/µL with neutrophilia, a C-reactive protein (CRP) of 45 mg/L, and normal liver function tests. A CT scan of the abdomen and pelvis with IV contrast is performed, the relevant images of which are shown. Given the patient's presentation and imaging findings, which of the following is the MOST appropriate next step in management?

A 4-year-old presents with abdominal distension, pain, and weight loss over several weeks. On examination, a firm, irregular abdominal mass is palpable. Blood tests show mild anaemia. The provided image is an axial CT slice of the abdomen. Considering the clinical presentation and the findings demonstrated in the image, which of the following investigations is the MOST appropriate initial step to establish a definitive diagnosis?

A 68-year-old male presents to the ED with colicky abdominal pain, nausea, and vomiting. He reports no bowel movements for 3 days. His abdomen is distended and tender. An X-ray is performed. Given the findings, what is the MOST likely underlying cause of this patient's condition?

A 68-year-old male presents to the ED with severe groin pain and a palpable mass. He reports a history of a reducible bulge in the same area, but today it is firm and tender. He denies fever, nausea, or vomiting. Examination reveals stable vital signs. Review the provided image. What is the MOST appropriate next step in management?

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 68-year-old male with a history of chronic hepatitis C presents to the clinic complaining of right upper quadrant abdominal pain and unintentional weight loss of 10 kg over the past 6 months. His past medical history is significant for well-controlled hypertension and hyperlipidemia. Physical examination reveals mild hepatomegaly. Laboratory investigations show elevated alpha-fetoprotein (AFP) levels. A contrast-enhanced ultrasound of the liver is performed, and representative images are shown. Based on the imaging and clinical context, which of the following is the MOST appropriate next step in management?

A 58-year-old male presents with left lower quadrant abdominal pain and a low-grade fever. The provided image was obtained. What is the most likely diagnosis?

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?

An 80-year-old male presents to the emergency department with sudden onset of severe right groin pain and a non-reducible bulge. He has a history of a reducible inguinal hernia. Vitals are stable. A CT scan of the pelvis is performed. Considering the clinical presentation and the provided imaging, what is the most appropriate immediate management step?

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. Considering the patient's clinical presentation and the findings demonstrated in the provided image, which of the following represents the most appropriate immediate next step in her management?

A 3-year-old presents with abdominal distension and vague pain. Vitals are stable. An abdominal CT is performed (image attached). Elevated levels of HVA and VMA are noted in the urine. What is the MOST likely origin of the primary lesion?

A 68-year-old male presents with abdominal pain, distension, and obstipation for 3 days, with a history of multiple abdominal surgeries. Vitals are HR 110, BP 110/70, T 37.8. Exam shows a distended abdomen with high-pitched bowel sounds. An upright abdominal X-ray is shown. Considering the clinical context and the imaging findings, which of the following is the MOST likely expected outcome with initial non-operative management?

A 45-year-old patient with a known history of multiple cutaneous vascular lesions presents to the emergency department with a 2-day history of intermittent, colicky abdominal pain and nausea. They report chronic fatigue and have a history of iron deficiency anaemia requiring occasional transfusions. On physical examination, vital signs are stable (BP 120/80, HR 75, RR 16, Temp 36.8°C). There is mild diffuse abdominal tenderness without guarding or rebound. Cutaneous examination reveals multiple blue-purple papules and nodules scattered over the trunk and limbs. An abdominal CT scan is performed. Considering the patient's clinical presentation, known history, and the findings demonstrated in the provided image, 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 55-year-old renal transplant recipient on long-term immunosuppression presents with a 2-week history of low-grade fever, malaise, and dull right upper quadrant discomfort. Physical exam is unremarkable except for mild tenderness. Labs show mild leucocytosis and elevated CRP. Imaging is shown. What is the most appropriate next step to determine the specific aetiology of the findings?

A 68-year-old man presents to the emergency department with a 2-day history of worsening left lower quadrant abdominal pain, associated with subjective fever, chills, and nausea. He reports some recent constipation. His past medical history includes hypertension and hyperlipidaemia, both well-controlled on medication. On examination, his temperature is 38.5°C, pulse 95 bpm, BP 130/80 mmHg, respiratory rate 18/min, oxygen saturation 98% on room air. Abdominal examination reveals tenderness and guarding in the left iliac fossa, with mild rebound tenderness. Bowel sounds are reduced. Digital rectal examination is unremarkable. Blood tests show a white cell count of 15 x 10^9/L (neutrophils 85%), haemoglobin 145 g/L, platelets 250 x 10^9/L, C-reactive protein of 120 mg/L. Urea, electrolytes, and creatinine are within normal limits. Liver function tests are normal. A CT scan of the abdomen and pelvis is performed (image provided). Considering the clinical presentation and the specific findings demonstrated in the provided image, which of the following interventions is most likely to be required in addition to intravenous antibiotics and supportive care?

A 3-week-old male infant is brought to the emergency department by his parents. They report that he has been experiencing projectile vomiting after every feed for the past week. The vomiting is non-bilious. He appears dehydrated, with sunken fontanelles and decreased skin turgor. His weight has decreased since his last check-up. An abdominal X-ray is ordered, the results of which are shown. What is the most appropriate next step in the management of this patient?

A 68-year-old male with a history of reflux presents with epigastric pain and vomiting. An X-ray is performed (shown). What is the most likely complication?

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 55-year-old male presents with LLQ pain, fever, and increased WBC. A CT scan is performed. He is hemodynamically stable. Based on the image, which of the following is the MOST appropriate initial management strategy?

A 65-year-old man presents to his GP with a 2-day history of constant, dull aching pain in the left lower quadrant of his abdomen. He reports mild nausea but no vomiting. His bowel movements have been normal. He denies fever or chills. His past medical history includes well-controlled hypertension. On examination, he is afebrile (37.2°C), blood pressure is 135/85 mmHg, heart rate 72 bpm, respiratory rate 16 bpm. Abdominal examination reveals mild tenderness on deep palpation in the left iliac fossa, without guarding or rebound tenderness. Bowel sounds are normal. Digital rectal examination is unremarkable. Laboratory investigations show a white cell count of 10.5 x 10^9/L (normal range 4-11) and a C-reactive protein of 25 mg/L (normal <5). A CT scan of the abdomen and pelvis is performed (image provided). Considering the patient's clinical presentation and the findings demonstrated in the provided image, which of the following represents the most appropriate initial management strategy?

A 62-year-old male presents to the emergency department complaining of worsening abdominal pain, fatigue, and a 10kg unintentional weight loss over the past 3 months. He reports a history of peptic ulcer disease treated with long-term proton pump inhibitors. Physical examination reveals mild hepatomegaly and trace ascites. Initial laboratory investigations show elevated alkaline phosphatase and gamma-glutamyl transferase (GGT), with normal bilirubin and transaminases. A CT scan of the abdomen and pelvis with contrast is performed, and relevant images are shown. Given the clinical presentation and the findings on the imaging, which of the following is the MOST appropriate next step in management?

A 70-year-old male presents with a painful groin mass and constipation. The provided image was taken. What is the most appropriate next step?

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 findings demonstrated in the provided images, which of the following management approaches is most likely indicated?

A 64-year-old woman presents with a history of colicky pain. An ultrasound was performed. What is the MOST appropriate next step in management?

A 32-year-old male with Crohn's disease presents with increased abdominal pain and diarrhea. Review the imaging. What is the MOST appropriate next step?

A 68-year-old woman presents to the emergency department with right upper quadrant abdominal pain, fever, and jaundice. Her past medical history is significant for hypertension and hyperlipidemia. Initial laboratory investigations reveal elevated bilirubin, alkaline phosphatase, and gamma-glutamyl transferase (GGT) levels. An ultrasound of the abdomen showed dilated intrahepatic ducts, but the common bile duct was difficult to visualize due to overlying bowel gas. An ERCP was performed, and an image obtained during the procedure is shown. Following successful removal of the obstruction, what is the MOST appropriate next step in managing this patient's condition?

A 68-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed. Based on the imaging, what is the MOST appropriate next step in management?

A 63-year-old man presents with increasing postprandial fullness and epigastric discomfort. A CT scan of the abdomen is performed. Based on the image, what is the MOST appropriate next step in management?

A 63-year-old man presents to the emergency department complaining of increasing shortness of breath and epigastric discomfort over the past several months. He reports feeling full quickly after eating only small amounts. He denies any chest pain, fever, or recent weight loss. His past medical history includes hypertension and well-controlled type 2 diabetes. He takes lisinopril and metformin daily. On examination, his vital signs are stable: blood pressure 130/80 mmHg, heart rate 82 bpm, respiratory rate 18 breaths/min, and oxygen saturation 96% on room air. Auscultation of the chest reveals decreased breath sounds at the left base. Abdominal examination reveals mild epigastric tenderness to palpation, but no rebound tenderness or guarding. The provided image was obtained. Which of the following is the MOST appropriate next step in management?

A 3-year-old boy presents with sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. His vital signs are stable. On examination, he is pale. An abdominal ultrasound is performed, shown in the image. Based on the clinical presentation and imaging findings, what is the most appropriate next step in management?