A 56-Year-Old Man Comes to the Emergency Department Due to Worsening

question 299

Multiple Choice

A 56-year-old man comes to the emergency department due to worsening abdominal discomfort and distension.  The discomfort is diffuse and began 1 day prior, after the patient woke up from a night of heavy drinking that included a fall in which he struck his lower abdomen.  He has also had increasing abdominal girth over the past day.  Medical history includes alcohol use disorder and hypertension; there is a remote history of appendectomy.  Review of systems is negative for fever or vomiting but positive for inability to void.  Temperature is 36.7 C (98.1 F) , blood pressure is 158/90 mm Hg, and pulse is 90/min.  Heart and lung sounds are normal.  The abdomen is distended, mildly tender to palpation diffusely, and dull to percussion with a positive fluid wave.  Laboratory results are as follows: Which of the following is the most likely diagnosis in this patient?

• A)Bladder rupture
• B)Liver cirrhosis
• C)Rhabdomyolysis
• D)Small-bowel perforation
• E)Splenic laceration

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Definitions:

Tissue Fluids

The fluid component of connective tissue, which bathes and surrounds the cells in tissues, providing them with nutrients and removing waste products.

Reticular Connective Tissue

A type of connective tissue with a network of reticular fibers that supports organs in the lymphatic system and bone marrow.

Dense Connective Tissues

A type of connective tissue characterized by high levels of collagen fibers, providing strength and durability.

Elastic Connective Tissue

A type of connective tissue composed of elastic fibers that allows the tissue to return to its original shape after being stretched or compressed.