buzz
Forum Newbie
Topics: 4
Posts: 18
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a 50 year old man presents with shifting abdominal pain, vomitting for several days. he also complains of not being able to pass stools ( no flatulence either) for 3 days. on examination, abdomen is distended, no bowel sounds, tenderness with no guarding or rigidity.
labs
hb 14, hct 40, bun6 mMol/l, ph 7.3
next modality of treatment?
1. analgesic and laxative
2. laxative only, no analgesic
3. barium enema
4. laprotomy
5. laproscopy
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| tasneembanu
Forum Guru
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can it be barium enema?
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| luckiest
Forum Senior
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:?: If we ignore the choices.I mean in practical way should plain film abdomen be done first?
I mean in my contry if we suspect bowel obstruction we would X-ray first.
By the way I choose barium enema from the choice too.
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| buzz
Forum Newbie
Topics: 4
Posts: 18
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hey guys, in fact barium enema and laxatives are contradicted in intestinal obstruction with symptoms more than 2 days. you dont want to increase the intestinal motility if there's an obstruction for fear of perforation and gangrene. same reason why you wont do a laproscopy. Also, very important the patient is in acidosis and you want to relieve the obstruction right away.
so the answer is
immediate laprotomy.
luckiest, i dont know the answer to your question, you are right, what if x ray abdomen is a choice, well, in my country too, the patient would be sent for an x ray abdomen before a laprotomy.
so, lets put it to the forum????
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| md2besoon
Forum Elite
Topics: 33
Posts: 228
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<:nope:> all the answers to this q does not make any sanse, do chem-7, x-ray, give some iv fluids, even in he needs surgery asap, anestesiologist will not touch him at this moment. so if the right choice is "laparatomy" add to this "in local anaestesia by crazy surgeon" 
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| usmleasr
Forum Guru
Topics: 105
Posts: 970
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what is the most commom cause of intestinal obstruction?
answering this question will by itself say about most common management.. 
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| buzz
Forum Newbie
Topics: 4
Posts: 18
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i agree with luckiest when he says that x ray abdome should have been one of the choices,
but ROBAL, anaesthiologist wont touch the patient at this time?????????? very_confused what does that mean.???????
i mean any amount of iv fluids is not going to stabilize the patient, once a diagnosis of intestinal obstruction has been made and as luckiest said, once the x ray abdomen in confirmatory, especially if the patient is in acidosis, IMMEDIATE EXPLORATORY LAPROTOMY AND RELIEF OF OBSTRUCTION IS THE NEXT STEP, NO DOUBT.
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| buzz
Forum Newbie
Topics: 4
Posts: 18
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usmlesr
the most common cause of intestinal obstruction in the US is adhesions, accounting for 70 percent cases ( adhesions can be post inflammation, post surgery etc etc),
the second most common cause is hernial obstruction
then there are other causes like diverticular disesase, colonic ca, volvulus, etc etc.
DEFINITIVE TREATMENT OF ADHESIONS AND HERNIAL OBSTRUCTION/STRANGULATION IS LAPROTOMY.
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| usmleasr
Forum Guru
Topics: 105
Posts: 970
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hi buzz,
u r correct..MCC is adhesions...(mostly post surgical).. in USA..
what i meant is ... for a surgery induced problem do u want to go for surgery again?? ... basically try conservative with NPO, NGT,IVF...this will be the first step in management...(ofcourse PE looking at hernial orifices r also important)
and as u said if it does not respond to conservative treatment then go for surgery as a lost resort..(or if signs of peritonitis +)..to relieve obstruction and as well create some more future adhesions ..
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| buzz
Forum Newbie
Topics: 4
Posts: 18
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LOL
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