ROSH Gastrointestinal Practice Exam

What is the most appropriate management for a patient with abdominal pain and vomiting, along with a midline bulge?

1. Administer broad-spectrum antibiotics and attempt reduction

2. Administer broad-spectrum antibiotics and obtain a plain radiograph

3. Administer broad-spectrum antibiotics and obtain emergent surgical consultation

4. Administer broad-spectrum antibiotics then obtain a CT scan of abdomen

The correct answer is: Administer broad-spectrum antibiotics and obtain emergent surgical consultation

The most appropriate management for a patient presenting with abdominal pain, vomiting, and a midline bulge is to administer broad-spectrum antibiotics and obtain an emergent surgical consultation. This clinical presentation suggests the possibility of an acute abdominal condition that could involve a hernia, which may be incarcerated or strangulated. In such cases, prompt surgical evaluation is crucial because delay in management can lead to serious complications, including bowel ischemia or perforation if a strangulated hernia is present. The presence of a midline bulge indicates a structural problem that often requires surgical intervention. Administering broad-spectrum antibiotics is important to manage potential infections that can accompany these conditions, but the main focus must be on surgical assessment and intervention. While imaging such as a CT scan can provide valuable information, it should not delay the surgical consultation in a case where a surgical emergency is suspected. Therefore, seeking an immediate surgical opinion coupled with the administration of antibiotics is the best course of action to ensure timely and effective management of the patient’s condition.