abdominal pain

A 64-year-old woman presents for an elective abdominal ultrasound. Several months ago, she experienced a few episodes of intermittent, moderate-to-severe right upper quadrant pain that resolved spontaneously within a few hours each time. She denies any associated fever, chills, nausea, vomiting, or jaundice during those episodes or currently. She has no significant past medical history other than well-controlled hypertension. On examination today, she is afebrile, her vital signs are stable, and her abdomen is soft and non-tender. Routine blood tests performed prior to the ultrasound, including full blood count, liver function tests (bilirubin, alkaline phosphatase, AST, ALT, GGT), amylase, and lipase, are all within their respective normal reference ranges. The provided image is a representative view obtained during her ultrasound examination. Considering the patient's history, current clinical status, and the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A previously healthy 3-year-old boy presents with colicky abdominal pain and non-bilious vomiting. Physical exam reveals a palpable abdominal mass in the RUQ. An ultrasound is performed, revealing the finding shown. What is the MOST likely lead point?

A 55-year-old man presents with 2 days of left lower quadrant pain and mild constipation. He denies fever, nausea, or vomiting. On examination, he is afebrile, BP 120/70, HR 65, O2 sat 99% on air. There is mild LLQ tenderness without guarding or rebound. Bloods show WCC 11.5, CRP 30. A CT scan is performed. Considering the clinical presentation and the findings demonstrated in the image, what is the most appropriate initial management plan?

A 64-year-old woman with a history of intermittent, self-resolving right upper quadrant pain presents for evaluation. She denies fever, chills, or jaundice, and her physical examination is unremarkable. Routine blood tests, including liver function tests and amylase, are within normal limits. An abdominal ultrasound was performed, and a representative image is shown. Based on the findings in this image and her clinical presentation, what is the most appropriate next step in management?

A 3-year-old boy presents with intermittent abdominal pain, vomiting, and currant jelly stools. An ultrasound is performed, revealing the finding shown. What is the MOST appropriate next step in the management of this patient?

A 58-year-old male presents with vague abdominal pain and unintentional weight loss. He has a history of working on a sheep farm. The provided imaging was obtained. Which of the following serological tests is MOST appropriate?

A 45-year-old male with a known history of Blue Rubber Bleb Naevus Syndrome, characterised by recurrent gastrointestinal bleeding and multiple cutaneous vascular lesions, presents to the emergency department with acute onset severe, colicky abdominal pain, nausea, and vomiting. On examination, his abdomen is distended and diffusely tender with reduced bowel sounds. Vital signs are within normal limits. An urgent abdominal CT scan is performed. Based on the clinical presentation and the findings demonstrated in the image, what is the most appropriate immediate next step in management?

A 62-year-old man presents to his general practitioner with a 6-month history of a bulge in his groin that appears when he strains or coughs. He reports mild discomfort but no severe pain. On examination, the GP identifies a soft, reducible mass in the right groin area that appears to emerge through the superficial inguinal ring when the patient coughs. The mass reduces spontaneously when the patient lies down. Which of the following is the most appropriate next step in management, according to Australian guidelines?

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 32-year-old woman presents to the emergency department with severe right lower abdominal pain, nausea, and vomiting. She reports that the pain started suddenly a few hours ago and has been worsening. Her last menstrual period was two weeks ago. On examination, she has tenderness and guarding in the right lower quadrant. A pregnancy test is negative. What is the most likely diagnosis?

A 68-year-old male presents to the ED with severe groin pain and a palpable mass. He reports constipation and inability to pass flatus for 24 hours. Examination reveals tenderness and erythema. A CT scan is performed. What is the MOST appropriate next step in management?

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 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 68-year-old male presents to the ED with abdominal distension, obstipation, and vomiting. He reports a history of multiple abdominal surgeries. An upright abdominal X-ray is performed. Based on the image, what is the MOST appropriate next step in management?

A 6-month-old infant presents for a routine check-up. The mother reports the infant is feeding well and has normal bowel movements. On examination, the infant is active and alert with normal vital signs. The abdomen is soft and non-tender. The image shows the infant's abdomen. What is the most appropriate next step in management?

A 70-year-old male presents with jaundice and abdominal distension. The provided image was obtained. What is the MOST likely underlying cause of the jaundice?

A 45-year-old male presents with intermittent abdominal pain and melena. The provided image was obtained. What is the most appropriate next step in management?

A 6-month-old male infant is brought to the emergency department by his parents. They report that they have noticed a bulge on his abdomen that seems to get larger when he cries. The infant is otherwise healthy, feeding well, and has normal bowel movements. On examination, the infant is afebrile, and his vital signs are within normal limits. The abdomen is soft and non-tender. Palpation reveals a soft, reducible mass at the umbilicus, as shown in the image. What is the MOST appropriate next step in the management of this patient?

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 72-year-old presents with acute cholangitis (fever, jaundice, RUQ pain). LFTs show obstructive pattern. ERCP is performed for biliary decompression and stone extraction. Following successful cannulation and cholangiography, the image is obtained. Based on the findings demonstrated in the image, what is the most appropriate immediate next step during this procedure?

A 72-year-old male presents with vomiting and abdominal pain. An abdominal X-ray is performed. What is the MOST likely underlying cause?

A 3-year-old boy presents with a 12-hour history of intermittent, severe abdominal pain, non-bilious vomiting, and decreased activity. Parents report redcurrant jelly stool. On exam, a palpable mass is noted. Vitals are stable. An ultrasound is performed (shown above). Considering the clinical picture and the image findings, which non-surgical intervention is indicated?

A 62-year-old male presents to the emergency department with right upper quadrant abdominal pain, weight loss, and jaundice. He has a known history of chronic hepatitis C infection. His vital signs are stable. Physical examination reveals hepatomegaly and mild ascites. The patient denies any alcohol consumption. Laboratory investigations reveal elevated alpha-fetoprotein (AFP) levels. A CT scan of the abdomen with and without contrast is performed, as shown. Based on the imaging and clinical findings, what is the MOST appropriate next step in management?

A 32-year-old male presents to the emergency department complaining of intermittent abdominal pain, nausea, and vomiting for the past 24 hours. He reports passing a small amount of blood in his stool this morning. He denies any fever or chills. His past medical history is significant for multiple cutaneous hemangiomas, which he has had since childhood. On physical examination, his abdomen is mildly distended and tender to palpation in the periumbilical region. Bowel sounds are hyperactive. The patient is hemodynamically stable. A CT scan of the abdomen is performed, the results of which are shown. Given the clinical presentation and imaging findings, what is the MOST appropriate next step in the management of this patient?

A 45-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and abdominal pain. He has a history of type 2 diabetes and hypertension. On examination, he has a palpable mass in the left upper quadrant of the abdomen. Laboratory tests reveal anemia and elevated serum lactate dehydrogenase (LDH). A CT scan of the abdomen shows splenomegaly and multiple hypodense lesions in the spleen. What is the most likely diagnosis?

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 3-year-old boy presents to the emergency department with a one-week history of abdominal pain, decreased appetite, and irritability. His parents also report that he has been increasingly tired and pale. On examination, the child is noted to have a palpable abdominal mass. A CT scan of the abdomen is performed, the axial view is shown. Based on the image and clinical presentation, which of the following is the MOST appropriate next step in management?

A 28-year-old with Crohn's presents with new fever and abdominal pain. The patient's CRP is elevated. Review the imaging. What is the MOST appropriate next step?

A 62-year-old woman presents with right upper quadrant pain, fever, and leukocytosis. An abdominal CT scan is performed, as shown. She has a history of similar episodes that resolved spontaneously. What is the MOST appropriate next step in management?

A 32-year-old male with Crohn's disease presents with worsening abdominal pain and diarrhea despite being on maintenance infliximab. He denies fever or blood in his stool. An abdominal CT and MRI are performed. Based on the imaging, what is the MOST appropriate next step in management?

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 58-year-old woman presents with persistent fatigue, muscle weakness, and vague abdominal pain. Her serum calcium is 3.2 mmol/L (2.1-2.6 mmol/L), and PTH is 190 pg/mL (10-65 pg/mL). Renal function is normal. She denies any family history of endocrine disorders. Imaging studies are performed, as shown. What is the MOST appropriate next step in managing this patient?

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 68-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and nausea for 3 days. His WBC count is 14,000. A CT scan of the abdomen and pelvis is performed, the axial view is shown. What is the most appropriate next step in management?

A 28-year-old woman presents with pelvic pain that started suddenly 2 days ago. Her periods are irregular. She denies fever or vomiting. The shown CT was performed. What is the MOST likely diagnosis?

A 32-year-old male with a 10-year history of Crohn's disease presents with worsening abdominal pain and increased frequency of bowel movements. He reports no fever or weight loss. Physical examination reveals mild tenderness in the right lower quadrant. His inflammatory markers are elevated. Review the provided imaging. 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 findings demonstrated in the provided images, which of the following management approaches is most likely indicated?

A 55-year-old man presents to the emergency department with sudden onset severe abdominal pain radiating to the back. He has a history of hypertension and is a smoker. On examination, he is diaphoretic and in distress, with a blood pressure of 90/60 mmHg and a heart rate of 110 bpm. Abdominal examination reveals a pulsatile mass in the midline. What is the most likely diagnosis?

A 55-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and abdominal discomfort. He has a history of chronic hepatitis B infection. On examination, he has mild hepatomegaly and jaundice. Blood tests reveal elevated liver enzymes and alpha-fetoprotein levels. An ultrasound of the abdomen shows a 3 cm lesion in the right lobe of the liver. What is the most likely diagnosis?

A 28-year-old woman presents to the emergency department with severe lower abdominal pain and vaginal bleeding. She is 8 weeks pregnant by last menstrual period. She reports no fever or chills. On examination, her blood pressure is 100/60 mmHg, heart rate is 110 bpm, and she appears pale and diaphoretic. Abdominal examination reveals tenderness in the lower quadrants without rebound tenderness or guarding. A pelvic examination shows a closed cervical os with moderate bleeding. A bedside transvaginal ultrasound reveals an empty uterus. Which of the following is the most appropriate next step in management?

A 3-year-old boy presents with a 12-hour history of intermittent, severe abdominal pain, drawing his legs up to his chest. He has vomited several times. His vital signs are stable: HR 110, BP 95/60, RR 24, Temp 37.2°C. On examination, he is irritable but comfortable between episodes of pain. His abdomen is soft but mildly distended. A focused abdominal ultrasound is performed, yielding the image provided. Based on the clinical presentation and the findings shown, what is the most appropriate initial therapeutic intervention?

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 3-year-old boy presents with sudden onset intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is pale but haemodynamically stable. Abdominal examination reveals a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). What is the most appropriate next step in management?

A 65-year-old male presents with acute LLQ pain. The provided image was obtained. What dietary advice is most appropriate upon resolution of acute symptoms?

A 45-year-old woman presents to her GP with recurrent episodes of biliary colic. An ultrasound confirms the presence of multiple gallstones. She is otherwise healthy with no significant past medical history. After discussing management options, she opts for a laparoscopic cholecystectomy. Which of the following is the MOST appropriate next step in her preoperative assessment, according to Australian guidelines?

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 65-year-old man presents to the emergency department with a 2-day history of worsening left lower quadrant abdominal pain, associated with fever and chills. He reports a change in bowel habit with increased constipation. On examination, he is febrile at 38.6°C and has significant tenderness and guarding in the left iliac fossa. His white cell count is 18 x 10^9/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 represents the most appropriate initial management step in addition to intravenous antibiotics?

A 64-year-old woman presents for follow-up after experiencing episodes of right upper quadrant pain several months ago, which resolved spontaneously. She denies fever, jaundice, or current abdominal discomfort. Routine blood tests including LFTs are within normal limits. An abdominal ultrasound was performed, with a representative image provided. Considering her history and the imaging findings, what is the most appropriate next step in management?