Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
S0897200
The first step that I will take for this 73 year old lady would be to take a second and
look at her from the end of the bed and decide whether she appears distressed or
comfortable, as that will direct my initial management along two paths;
1) traditional method of historyexaminationmanagement
2) simultaneous resuscitation and history taking using ABCD approach
History:
Pain Type, nature, onset, radiation, shifting, alleviating/exacerbating factors,
associated symptoms, previous occurrence
VomitingType, colour, amount, contents, association with pain/food intake
Important to ask about bowel habits, ability to pass flatus at present , urinary
symptoms, known hernias, Weight loss, fatigue, food intake, health of other family
members
Also ask about history of gallstones, volvolus
Other Hospital Admissions
Past History:
Already known as above
Investigations:
FBC WCC, HGB, Platelet levels
U&E Renal Function/electrolyte abnormality
LFT Liver Function
Amylase pancreatitis
Coagulation Screen need for Vitamin K
CRP
ABG’s degree of acidosis
ECG MI
Erect CXRair under diaphragm/Pneumonia/aspiration
ABD-XR distended loop of bowel/ cut off point
Urine dipstick nitrates/ketones
BM hyperglycemia
Differential Diagnosis:
1) Obstruction secondary to
Adhesions (60%)
Hernia (20%)
Malignancy (5%)
Volvulus
Gallstone Ileus
Carcinoid
Intussusception
Stricture (Ischaemic, Crohn’s, TB)
SMA Syndrome
2)Ileus
3)Pseudo-Obstruction
4)Sepsis
Initial Management:
The decision to perform surgery or not plus its urgency would depend on
the findings on history, examination and investigative results, however the initial
management stays the same in either case. This would include:
Further Imaging: If no immediate indication for surgery then further imaging would
be of benefit:
Total words:500