ABSTRACT
A 55-year-old man, with a 2-year history of dyspepsia, is brought to the emergency department following a sudden onset of severe epigastric pain. The pain is made worse on movement and the patient has also experienced one episode of haematemesis. On examination, the patient is cold, sweating profusely and taking shallow breaths. The abdomen is rigid and bowel sounds are absent. A plain film chest radiograph reveals free air under the diaphragm. The most likely diagnosis is
A. Perforated appendicitis B. Acute cholecystitis C. Acute pancreatitis D. Myocardial infarction E. Perforated peptic ulcer
A 26-year-old woman arrives at the emergency department with unbearable intense right iliac fossa pain. Earlier that day, she was experiencing ‘on and off’ moderate pain in the umbilical area which gradually moved over to the right iliac fossa. Associated symptoms include anorexia, nausea and vomiting. On examination, the patient is pyrexial and there is rebound tenderness and guarding over the right iliac fossa. A beta-human chorionic gonadotrophin test is negative. What should you do next?
