A 28-year-old male with a 3-year history of chronic lower back pain presents to the emergency department with sudden-onset severe epigastric pain that began 2 hours ago while he was at work. He has been taking naproxen 500 mg twice daily for the past 6 months. On examination, he appears acutely ill with severe epigastric tenderness, voluntary guarding, and rebound tenderness. Vital signs are: BP 110/68 mmHg, HR 102/min, RR 20/min, temperature 37.4°C. A stat upright chest X-ray demonstrates a 3-mm linear collection of free air beneath the right hemidiaphragm. Laboratory studies show WBC 8,200/μL, hemoglobin 14.2 g/dL, and normal liver function tests. Which of the following is the most appropriate initial management?
- A)Immediate surgical consultation for exploratory laparotomy and repairGABARITO
- B)Nasogastric tube placement, high-dose intravenous proton pump inhibitor, and serial abdominal examinations
- C)Urgent esophagogastroduodenoscopy with endoscopic hemostasis
- D)Empiric broad-spectrum antibiotics and observation with repeat imaging in 6 hours
- E)CT angiography of the abdomen and pelvis to evaluate for other sources of perforation
Explicação
This patient has a perforated peptic ulcer with pneumoperitoneum, a surgical emergency. The classic triad of acute NSAID-induced ulcer perforation includes sudden severe epigastric pain, peritoneal signs (guarding/rebound), and free air on imaging. Perforation... Ver explicação completa e trilha adaptativa →