A 40-Year-Old Man Is Evaluated in the Hospital After Being

question 512

Multiple Choice

A 40-year-old man is evaluated in the hospital after being admitted for acute alcohol-induced pancreatitis 24 hours ago.  He has been receiving aggressive intravenous hydration and pain control.  Over the past 2 hours, the patient has become increasingly restless and now reports difficulty breathing and abdominal distension.  Blood pressure is 80/60 mm Hg, pulse is 122/min, and respirations are 28/min.  Heart and lung sounds are normal.  The abdomen is significantly distended and tense.  Bowel sounds are decreased.  Bilateral lower extremity and flank edema are present.  Chest x-ray reveals basilar atelectasis but no other infiltrates.  His urine output has markedly decreased over the past 2 hours.  Which of the following pathophysiologic changes are most likely present in this patient at this time compared to a few hours earlier?

• A)Decreased cardiac preload
• B)Decreased central venous pressure
• C)Decreased lower extremity venous pressure
• D)Increased abdominal wall compliance
• E)Increased cardiac output

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Definitions:

Sunbathing

The act of sitting or lying in natural sunlight, often for the purpose of tanning the skin or for pleasure.

Anosmia

The loss of the sense of smell, either total or partial, which can be temporary or permanent.

Membranous Structures

Structures composed of membrane, typically referring to parts of cells such as organelles enveloped by lipid bilayers.

Tympanic Membrane

A thin membrane that separates the outer ear from the middle ear, also known as the eardrum, vibrating in response to sound waves.