one & only adernalline - vanco

[ArchivalUser]

A 24-year-old woman develops moderate, generalized abdominal pain of sudden onset and shortly thereafter faints. At the time of evaluation in the emergency department, she has regained consciousness, is pale, and has a blood pressure of 95/70 mm Hg and a faint pulse rate of 90/min. The abdomen is mildly distended and tender, with normal bowel sounds. Her hemoglobin is 7 g/dL. There is no history of trauma, but it is suspected that she might be bleeding into her abdomen, and a diagnostic peritoneal lavage is performed. The study shows that there is free blood in the peritoneal cavity. She denies the possibility of pregnancy because she has been on birth control pills since the age of 14 and has never missed taking them. Pelvic examination is normal, and a pregnancy test is negative. At laparotomy, the surgeons are likely to find which of the following?

A. Bleeding ovarian follicle
B. Ruptured abdominal aortic aneurysm
C. Ruptured ectopic pregnancy
D. Ruptured hepatic adenoma
E. Ruptured hepatic artery aneurysm

[ArchivalUser]

d.

[ArchivalUser]

thnx for ur love vanco

[ArchivalUser]

dd

[ArchivalUser]

_ agree with Adrenalline, DDD

[ArchivalUser]

DDD ruptured hepatic adenoma

[ArchivalUser]

The correct answer is: D.
Description:
The correct answer is D. A known complication of long-standing use of birth control pills is the development of hepatic adenomas that may rupture and bleed. A bleeding ovarian follicle (choice A) can give mild abdominal pain right at the midpoint of the menstrual cycle, but it would not produce bleeding of this magnitude.

An abdominal aortic aneurysm (choice B) would be very rare at this age, and bleeding typically begins retroperitoneally with excruciating back pain. Once the aneurysm ruptures into the peritoneal cavity, complete vascular collapse ensues.

An ectopic pregnancy (choice C) is the first thought when a sexually active young woman has spontaneous intra-abdominal bleeding, but in this case it has been ruled out by the history, the pelvic examination, and the pregnancy test.

Other visceral aneurysms (choice E) can indeed bleed, and have a tendency to do so during pregnancy. They are very rare and favor the splenic artery. They can also occur in the hepatic artery, but the odds are extremely low.