ROSH Gastrointestinal Practice Exam

A 73-year-old man presents with vomiting and abdominal pain. What is the most appropriate initial management?

1. Administer intravenous fluids and obtain a CT of the abdomen and pelvis

2. Place a nasogastric tube, begin antibiotics, and obtain a surgical consultation

3. Arrange for emergent colonoscopy

4. Perform a soap suds enema and administer polyethylene glycol

The correct answer is: Place a nasogastric tube, begin antibiotics, and obtain a surgical consultation

In the scenario of a 73-year-old man presenting with vomiting and abdominal pain, the most appropriate initial management involves placing a nasogastric tube, beginning antibiotics, and obtaining a surgical consultation. This approach is critical for several reasons. First, the presence of vomiting and abdominal pain in an elderly patient raises concern for potential bowel obstruction, perforation, or other surgical emergencies. A nasogastric tube is essential in this case to decompress the stomach by removing gastric contents and preventing further vomiting, which can help relieve symptoms and reduce the risk of aspiration. Starting antibiotics is also a key component of the management plan. The combination of abdominal pain and vomiting can indicate an underlying infection, such as appendicitis or diverticulitis. Antibiotics help manage potential sepsis and treat any intra-abdominal infection that may be present. Finally, obtaining a surgical consultation is crucial because surgical evaluation may be necessary, given that the underlying cause of the symptoms could require surgical intervention. Conditions like bowel obstruction or perforation often necessitate urgent surgery to prevent complications such as sepsis or bowel necrosis. On the other hand, while options involving CT imaging or endoscopy may be beneficial later in the workup, they are not the immediate priorities given the need to