70 yr diabetic female, presented with abdominal distension since 3 days. no H\o nausea,vomiting,fever, pr bleed. per abdo distended,soft, non tender, no guarding rigidity. pulse 80, bp 130/80. on pr roomy,no blood,mass or hard stools. x-ray s\o gaseous distension,no AF levels. CT plain+contrast s\o gas distended colon. probable diagnosis n further investigation n management?

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Picture is of paralytic ileus. Diabetic patients are prone to this condition due to decreased G.IT motility. Enquire about history of intake of loperamide or antispasmodics .Sub acute intestinal obstruction is another possibility due to chronic constipation. P/R examination.to feel for faecoliths and manual evacuation if present. Start with IV line ,fluids,NPO ,parenteral antibiotics including tiniba infusion till bowel sounds appear

Picture looks like paralytic ileus because of dyselectrolytemia.. NG aspiration, iv fluids, correction of electrolytes, gradually start orals and if accepting, build up gradually.. Once she is alright, it's worthwhile getting a colonoscopy done..

Subacute intestinal obstruction. Chronic Constipation may be etiology.

In view of above it seems to be paralytic ileus What about bowel sounds ? Plan conservative management with IV Fluids, antibiotics , Enema, multivitamins including vit B 12

Paralytic ilius.

Needs colonoscopy, CEA, FBT, Parkinson's evaluation and HbA1c with tight diabetic control

Large colon Obstruction ? volvulus...

Was hypokalemic...corrected. initially no sounds after correction sounds present. On n off passing loose stools with flatus.

Large gut obstruction probably sigmoid volulous needs exploration

Obstructions

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