A 42-Year-Old Woman Reports Bloating with Mild, Diffuse Abdominal Discomfort

question 473

Multiple Choice

A 42-year-old woman reports bloating with mild, diffuse abdominal discomfort 4 days after undergoing an elective cholecystectomy.  She has not passed gas since the surgery.  Perioperatively, she received antibiotics, morphine for pain, and metoclopramide for nausea.  Medical history is significant for hypertension, diabetes mellitus, and hyperlipidemia.  Blood pressure is 132/90 mm Hg and pulse is 76/min.  BMI is 33 kg/m².  Physical examination shows a distended, tympanic abdomen with decreased bowel sounds.  There is mild, diffuse tenderness but no rebound or guarding.  The remainder of the examination shows no abnormalities.  Which of the following is most likely contributing to this patient's current condition?

• A)Absence of bile storage reservoir
• B)Impaction of a gallstone in the ileum
• C)Metoclopramide
• D)Morphine
• E)Perioperative antibiotics
• F)Postoperative adhesions

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