A young female with Acute Pain Abdomen

A female aged 22 years who is on ATT for pulmonary Koch's (since 2 months) Chief Complaints Acute onset Pain Abdomen (Colicky) Bilious Vomiting Constipation (x 2 days) Physical Examination P/A- Distended, Tender, BS(-)

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Acute intestinal obstruction- considering multiple air fluid levels Most likely causes which are seen in a case of PULMONARY koch's are abdominal tuberculosis with obstruction due to 1 Small intestinal strictures . 2.multiple Adhesions Treatment should be conservative to start with 1.NPO 2 RT suction 3.IV fluids, 4.Parenteral antibiotics including metronidazole 5 A proctoclyss enema A CT enterography can help in pin - pointing site,of obstruction If obstruction is not relieved- surgery may be considered

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Acute intestinal obstruction Multiple fluid levels are meet Likely mechanical obstruction as colons are loaded with faecal matter Glycerine enema Electrolyte are to be compensated Iv fluids inj Ceftriaxozone Inj ondestron Inj pantaprazole Rest continue Check LFTS

Thanx dr Parveen Yograj sir
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Xray shows there multiple fluid labels in plain xray in erect postures seem to be case of obstruction. As the pt I an old patient if pulmonary koch' s then it may be assumed as obstruction of small intestines aloso affected by tuberculosis leading to narrowing of the lumen of small intestine mainly terminal part involving caecum causing obstruction of the passage of intestinal content may be multiple at different places or there may be formation band due to tuberculosis causing obstrution twisting of the arround the band or directly causing obstruction . Enterography may be helpful to see the narrowing if lumen if present Conservative treatment may be done by NPM Ryles tube suction IV drip to continue for nutrition or electrolytes if necessary Antispasmodic Practoclys enema Sr electrolyte estimation If obstruction relieved ok if not relieved after continueing 48 hours then exploratory laparotomy may be required to rieve the obstruction as required.

Thanks Dr Shivraj Agarwal
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Subacute intestinal obstruction?

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Intestinal obstruction...

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