Gastrointestinal system

Gastrointestinal system




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A 56-year-old woman is diagnosed with stage IV cholangiocarcinoma, for which she is receiving chemotherapy. Periodically, the patient develops ascites, for which abdominal paracentesis is performed. However, the patient was lost to follow-up. The patient is brought to the emergency department by her daughter with diffuse abdominal pain, nausea, vomiting, and altered mental status. On admission, temperature is 38.6°C (101.5°F), pulse is 100/min, respirations are 22/min, and blood pressure is 120/66 mm Hg. On physical examination, the abdomen is distended and shifting dullness and a fluid wave are present. There is diffuse guarding with abdominal palpation. Which of the following is the most likely cause of this patient’s symptoms?  

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Abdominal pain

bacterial peritonitis p. 399

Bacterial peritonitis (spontaneous) p. 399

Cirrhosis p. 398

bacterial peritonitis (spontaneous) p. 399

Ileus p. 395

bacterial peritonitis (spontaneous) p. 399


appendicitis p. 392

diverticulitis p. 392

spontaneous bacterial p. 399

Primary bacterial peritonitis p. 399

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Peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis may be localized or generalized and may result from a bacterial infection often due to the rupture of a hollow abdominal organ as may occur in abdominal trauma, appendicitis, or diverticulitis. Symptoms of peritonitis include severe abdominal pain, tenderness, and swelling, as well as fever, nausea, and vomiting. In severe cases, the abdomen may become rigid and distended, and the person may go into shock. Peritonitis is a medical emergency and requires prompt treatment with antibiotics and surgery if necessary.


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