Bowel Obstruction Signs And Symptoms

Bowel Obstructionsigns And Symptoms E9olo

Identify and describe the signs and symptoms associated with bowel obstruction, including the pathophysiology, physical exam findings, differential diagnosis, diagnostic testing, and treatment options.

Sample Paper For Above instruction

The clinical case involves a 50-year-old male with a past medical history (PMH) of diverticulitis who presents with abdominal pain, nausea, vomiting, and absence of bowel movements. The health history reveals that he experienced sudden onset of crampy lower abdominal pain, bloating, and inability to pass stool or gas over the past 24 hours. He reports previous episodes of constipation and has a history of recent surgery for hernia repair, which could predispose him to postoperative adhesions. The patient reports no significant weight loss, fevers, or chills.

On physical examination, the patient exhibited abdominal distension, tenderness localized to the lower quadrants, and hyperactive bowel sounds early on, which later became hypoactive. Palpation revealed guarding but no rebound tenderness. Digital rectal examination showed an empty rectal vault. Vital signs indicated mild tachycardia and low-grade fever, suggesting early systemic response to intestinal distress.

The differential diagnosis includes mechanical bowel obstruction, paralytic ileus, inflammatory bowel disease, intra-abdominal mass, and neoplasm. To confirm the diagnosis, laboratory tests such as a complete blood count (CBC) showed leukocytosis, indicating possible infection or inflammation. Electrolyte panels revealed hypokalemia and dehydration. Imaging studies, including abdominal X-ray, depicted dilated loops of small bowel with air-fluid levels. A computed tomography (CT) scan provided detailed visualization of the site and cause of obstruction, revealing a transition point near an adhesion.

The diagnosis is bowel obstruction, specifically postoperative adhesion-related small bowel obstruction. The etiology of this condition involves fibrous bands forming after surgery, leading to mechanical blockage of intestinal flow. The pathophysiology includes impaired transit of intestinal contents due to luminal narrowing or occlusion, increased upstream pressure, bowel distension, compression of blood vessels, and risk of ischemia and perforation if untreated.

Treatment approaches encompass initial conservative management with nasogastric tube decompression, intravenous fluid resuscitation to correct electrolyte imbalances, and bowel rest. Surgical intervention may be required if there is evidence of ischemia, perforation, or failure of conservative therapy. Patient education emphasizes the importance of recognizing worsening symptoms such as increasing pain, fever, or vomiting, prompt medical follow-up, and adherence to postoperative instructions to minimize adhesions. Follow-up includes clinical assessment, repeat imaging if necessary, and monitoring for complications such as bowel strangulation or perforation.

References

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