A 37-Year-Old Hospitalized Man Is Evaluated for Acute Onset of Intense

A 37-year-old hospitalized man is evaluated for acute onset of intense periumbilical abdominal pain associated with nausea and vomiting.  He has had 2 bowel movements since the pain started.  The patient has a history of alcohol and intravenous heroin abuse.  He was admitted 4 days ago for fever, chills, and shortness of breath and was diagnosed with acute bacterial endocarditis.  His blood cultures grew Staphylococcus aureus, and an echocardiogram showed vegetations on the mitral valve.  He is currently being treated with intravenous vancomycin.  On examination, the patient appears in significant distress and is restless.  Temperature is 37.5 C (99.5 F) , blood pressure is 150/90 mm Hg, pulse is 110/min and regular, and respirations are 18/min.  Pupils are equal, round, and 3 mm in size.  Lungs are clear to auscultation.  A 3/6 holosystolic murmur is present over the apex.  There is no third heart sound.  On abdominal palpation, mild diffuse tenderness is present.  There is no rigidity or rebound.  Bowel sounds are decreased.  Extremities are warm with normal pulses.  There is no tremor.  Abdominal x-rays reveal no free air or obstruction.  Which of the following is the most likely diagnosis?

A) Acalculous cholecystitis
B) Acute pancreatitis
C) Alcohol withdrawal
D) Intraabdominal abscess
E) Mesenteric ischemia
F) Opioid withdrawal
G) Papillary muscle rupture

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free