A 42-Year-Old Man Comes to the Emergency Department Due to Epigastric

question 208

Multiple Choice

A 42-year-old man comes to the emergency department due to epigastric abdominal pain.  The pain started acutely this morning and is constant and unrelated to eating.  The patient describes it as severe and worsening in intensity over time.  He also has had chills, rigors, and shortness of breath but has no chest pain, vomiting, melena, diarrhea, or hematochezia.  The patient was discharged from the hospital 3 days ago after a Roux-en-Y gastric bypass surgery with no intraoperative complications.  Medical history is otherwise significant for morbid obesity and type II diabetes mellitus.  He does not use tobacco or alcohol.  Temperature is 38.4 C (101.1 F) , blood pressure is 110/78 mm Hg, pulse is 125/min, and respirations are 21/min.  Oxygen saturation is 96% on room air.  Physical examination shows no scleral icterus and moist mucous membranes.  Heart sounds are normal with no murmurs, rubs, or gallops.  The lungs are clear to auscultation bilaterally.  The abdomen is tender to palpation in the epigastrium and is moderately distended.  There is no rebound tenderness or guarding.  The surgical incision shows mild surrounding erythema with no bleeding or drainage.  Laboratory studies are as follows: Which of the following is the best next step in management of this patient?

• A)Abdominal CT scan with oral contrast
• B)CT angiogram of the chest
• C)Esophagogastroduodenoscopy
• D)Hepatobiliary iminodiacetic acid (HIDA) scan
• E)Reassurance and symptomatic management
• F)Stool analysis for Clostridioides difficile toxin

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Definitions:

Voltage Drop

The reduction in voltage across a component or conductor due to resistance or impedance within the circuit.

RLC Series Circuit

A circuit consisting of a resistor (R), inductor (L), and capacitor (C) connected in series, affecting the impedance and phase of the circuit.

Power Factor

A measure of how effectively electrical power is converted into useful work output, expressed as the ratio of real power flowing to the load to the apparent power in the circuit.

RLC Series Circuit

An electrical circuit consisting of a resistor (R), inductor (L), and capacitor (C) connected in series, used to filter or resonate at certain frequencies.