A 52 yo woman who for the last couple of days has been vomiting small amounts, and has had abdominal pain. The pain has become more severe in the last 8 hours. She expresses surprise at her vomiting because she has eaten and drunk very little. She has not had a bowel movement in 2 days. Her medical history shows abdominal surgery for a hysterectomy twelve months ago, on a background of severe endometriosis. Vital signs: RR: 16 bpm SpO2: 99% BP: 110/60 mmHg (MAP 77 mmHg) HR: 118 bpm Temp: 37 oC Pain assessment: P = upon movement and at rest Q = aching with occasional stabbing pain R = peri umbilical (central abdomen) S = 8/10 T = Constant for last 48 hours Abdominal assessment: Inspection – distension, midline scar Auscultation – absent bowel sounds Palpation – general tenderness and guarding Percussion – gas-induced tympany Fluid status assessment: Weak pulses Pale and cool to the touch Cap refill > 3secs Reduced skin turgor – tongue furrowed Dry mucous membranes Last voided – last night Q1. Given Indrani's past medical history, and considering relevant anatomical structures and physiological processes, describe the pathophysiological process that has led to the severe pain in the periumbilical area and absent bowel sounds. In your answer, consider at least two other pathophysiological processes that could cause Indrani's acute abdomen, one due to gastrointestinal disorders and another due to disorders of the reproductive system, and state the specific information from the scenario that led you to disregard them, explaining why
A 52 yo woman who for the last couple of days has been vomiting small amounts, and has had abdominal pain. The pain has become more severe in the last 8 hours.
She expresses surprise at her vomiting because she has eaten and drunk very little. She has not had a bowel movement in 2 days. Her medical history shows abdominal surgery for a hysterectomy twelve months ago, on a background of severe endometriosis.
Vital signs:
RR: 16 bpm
SpO2: 99%
BP: 110/60 mmHg (MAP 77 mmHg)
HR: 118 bpm
Temp: 37 oC
Pain assessment:
P = upon movement and at rest
Q = aching with occasional stabbing pain
R = peri umbilical (central abdomen)
S = 8/10
T = Constant for last 48 hours
Abdominal assessment:
Inspection – distension, midline scar
Auscultation – absent bowel sounds
Palpation – general tenderness and guarding
Percussion – gas-induced tympany
Fluid status assessment:
Weak pulses
Pale and cool to the touch
Cap refill > 3secs
Reduced skin turgor – tongue furrowed
Dry mucous membranes
Last voided – last night
Q1. Given Indrani's past medical history, and considering relevant anatomical structures and physiological processes, describe the pathophysiological process that has led to the severe pain in the periumbilical area and absent bowel sounds. In your answer, consider at least two other pathophysiological processes that could cause Indrani's acute abdomen, one due to gastrointestinal disorders and another due to disorders of the reproductive system, and state the specific information from the scenario that led you to disregard them, explaining why.
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