Acute Surgical Presentations Flashcards

A 45-year-old man presents with sudden onset severe epigastric pain radiating to the back, nausea, and vomiting after a heavy meal. Serum lipase is 1200 U/L. CT shows peripancreatic fat stranding but no necrosis. What is the Ranson criterion at admission that most strongly predicts severity?

Answer: Serum glucose > 11 mmol/L

Serum glucose > 11 mmol/L (200 mg/dL) at admission is one of the five Ranson criteria assessed on presentation and is a key predictor of severe pancreatitis.

A 68-year-old woman with atrial fibrillation presents with sudden severe periumbilical pain out of proportion to physical exam findings, followed by bloody diarrhea 6 hours later. CT angiography shows filling defect in the superior mesenteric artery. What is the priority management?

Answer: IV heparin anticoagulation and urgent surgical or endovascular revascularization

Acute mesenteric ischemia from embolic occlusion requires immediate anticoagulation with heparin and urgent revascularization (surgical embolectomy or endovascular therapy) to prevent bowel infarction.

A 55-year-old man undergoes elective right hemicolectomy. On post-operative day 3 he develops fever, tachycardia, and worsening abdominal pain with peritoneal signs. CT shows free air and fluid. What is the most likely diagnosis and appropriate next step?

Answer: Anastomotic leak — return to OR for washout and stoma creation

Post-operative peritonitis with free air on POD 3 after bowel resection is anastomotic leak until proven otherwise, requiring urgent surgical re-exploration, washout, and fecal diversion.

A 30-year-old woman presents with right lower quadrant pain, low-grade fever, and elevated WBC. Ultrasound is non-diagnostic. CT with contrast shows a 9 mm appendix with periappendiceal fat stranding. She has no perforation or abscess. What is standard of care?

Answer: Laparoscopic appendectomy

Uncomplicated acute appendicitis confirmed on CT is treated with laparoscopic appendectomy, which is the current standard of care offering lower morbidity and faster recovery than open surgery.

A 72-year-old man with a known 5.5 cm abdominal aortic aneurysm presents with sudden onset severe back and flank pain, hypotension, and a pulsatile abdominal mass. BP is 80/50. What is the immediate management priority?

Answer: Permissive hypotension targeting SBP 50-70 mmHg and emergent surgical repair

Ruptured AAA is a surgical emergency; permissive hypotension (SBP 50–70 mmHg) is maintained to reduce further hemorrhage while rushing the patient to the OR for open or endovascular repair.

A 40-year-old man presents with a painful, irreducible bulge in the right groin below and lateral to the pubic tubercle that appeared during heavy lifting. He has nausea but no vomiting. What type of hernia is most likely and what is the next step?

Answer: Femoral hernia — urgent surgical repair due to high strangulation risk

A femoral hernia presents below and lateral to the pubic tubercle and carries a high risk of incarceration and strangulation, warranting urgent operative repair.

A 25-year-old man sustains a stab wound to the left chest at the 5th intercostal space, midclavicular line. He is hypotensive with distended neck veins and muffled heart sounds. Trachea is midline. What is the immediate intervention?

Answer: Pericardiocentesis or emergency thoracotomy for cardiac tamponade

Beck's triad (hypotension, JVD, muffled heart sounds) with a penetrating chest wound indicates cardiac tamponade, treated emergently with pericardiocentesis or left anterolateral thoracotomy.