I THINK THE pERITONITIS IS QUITE OBVIOUS, A MUST GO FOR "EXPLORATORY LAP "...a surgical emergency

the xray wont change the line of management

 

Abdominal Xray required before Exp Laparotomy.

 

http://emedicine.medscape.com/article/1829835-overview#showall

Ok it says- you can directly go for Ex-Lap!!!!!

 

Acute-onset abdominal pain and clinical findings suggestive of intra-abdominal pathology requiring emergency surgery
In these conditions, exploratory laparotomy is carried out both to diagnose the condition and to perform the necessary therapeutic procedure.

Peritonitis

Patients with clinical features of peritonitis may have pneumoperitoneum on erect chest and abdominal radiographs. They usually have a perforated viscus, most commonly the duodenum, stomach, small intestine, cecum, or sigmoid colon. Exploratory laparotomy is done first to determine the exact cause of pneumoperitoneum, followed by the therapeutic procedure. In the absence of pneumoperitoneum, appendicular perforation and intestinal ischemia are possible diagnoses; a high index of suspicion for possible intestinal ischemia should be maintained.
(In this taken from the link you have posted,it never says that Xray are not done first)

 

i think in USMLE ... nothing is absolutely true or false... when it comes to two close ans...

i mean if this case wasnt obvious n requiring a Lap anyways...

then Xray wud def be correct...

but here since Xray wont affect the lkine of management... and neither will it help much in further plan of action....direct ExLap is the ans...isnt it?


Now mr.tyagee

plz giv the correct ans...

itna tadpao mat !!)

 

I think the ans is B. this patient with long history of dyspepsia probably now has perforation leading to peritoneal peritoinits. so she needs ans xray to confirm diagnosis before exploratory laboratomy.

 

xray is the answer not lapro. cant find any clear expln in qbank:notsure:

 

now i m confused... its a gud quetn.

can cm up in d exam...

anyone with more substantial explanation or source ?

 

its perforation ,
so best next step is abdominal x-ray.

 

this pt has long history of dyspepsia means now pt has perforated stomach or duodenal ulcer, now presentation is guarding, regidity and tenderness, when ever these findings u seen in pt (guarding, regidity and tenderness) ALWAYS GO FOR EXP LAPROTOMY, ITS TRICK

 

are u sure?

can u atleast quote the source where this info is from ?

 

In severe abdominal sepsis, however, delays in operative management may lead to a significantly higher need for reoperations and to worse outcomes overall; early exploration (ie, prior to completion of diagnostic studies) may be indicated. Surgical intervention may include resection of a perforated viscus with re-anastomosis or the creation of a fistula. To reduce the bacterial load, a lavage of the abdominal cavity is performed, with particular attention to areas prone to abscess formation (eg, paracolic gutters, subphrenic area)
this is from link-
http://emedicine.medscape.com/article/1952823-overview
Here though they have mentioned prior to completion of diagnostic studies but have not mentioned prior to initiation of diagnostic studies.

 

sholder pain indicate gallbladder involvement ,so xray may be for perforation &stone??