A 23-year-old man is admitted to the hospital through the emergency depament with probable appendicitis. He has been having right lower quadrant abdominal pain for several days, which has been becoming increasingly worse. His temperature 39.2 C (102.6 F), blood pressure is 80/40 mm Hg, Pulse is 120/min, and Respiratory rate is 35/min. The abdomen is rigid with guarding. Multiple petechiae and purpura are present, and the patient is oozing blood from his oral mucosa. According to the patient's wife, he has not had bleeding problems in the past. The fact the abdomen is rigid with guarding suggests which of the following?
High-Yield Explanation
The usual reason for a patient to have a rigid abdomen is that peritonitis is present, and is causing severe pain related to perineal nerve fiber stimulation. The probable cause of the peritonitis is a ruptured appendix. This patient is also probably in shock, as indicated by the hypotension with increased respirations and hea rate, but this would not cause the abdominal guarding. The other answers are distractors.