Constipation and obstipation
A 76-year-old male with type 2 DM presented with complaints of constipation and obstipation that have been going on for a day. There was no vomiting. Physical examination; Vital Signs were normal, only abdominal tenderness Laboratory analysis was normal except hyponatremia. What's your diagnosis?
A case of large intestinal obstruction -Most likely faecal impaction due to chronic constipation is the likely cause but as age of patient is 76 years,- a Carcinoma rectum.,or sigmoid colon needs to be ruled out . Start with NPO, RT suction, IV fluids, parenteral antibiotics, practoclyss enema .As patient is having T2DM- chronic constipation is common in such cases - so enema can help. A CECT abdomen will be more important to localise the site of obstruction and to find out the cause
Large gut obstruction with hyponatrimea in a case diabetes Diabetes causes impaired functions of autonomic nervous system resulted gastroparesis, so constipation is usual problem IV fluid Rules gastric suction NPM IV antibiotic IV metronidazole Lactulose High bowel enema Prokinetics inj PPI High bowel enema Correction of metabolites If not releaves, go for USG/CT Refer to Surgeon
There is gross dilatation of entire colon with very few small bowel loops present This patient is elderly and diabetic The symptoms are of acute onset and are of one day duration On X ray, one can see that colon is dilated up to Rectus Therefore, I would like to propose following diagnosis 1) Ogilvie syndrome - That is pseudoobstruction of colon This is because, obstruction in rectum because of tumor or growth in rectum will not present with sudden severe symptom but in addition there will be symptoms of chronic constipation and bleeding per rectum, and early morning spurious diarrhoea - which is absent in this case. Therefore, Ogilvie syndrome appears to be first differential diagnosis 2) Second differential diagnosis is obstruction in rectum caused by tumor CT abdomen or sigmoidoscopy may help in confirmation of the diagnosis Treatment involves 1) Treatment of underlying pathology, such as electrolyte disturbance, diabetes, pain 2) use of motility agent such as Itopride, domperidone, erythromycin, prucalopride 3) Neostigmine is drug of choice, to be administered in ICU with cardiac monitoring
Intestinal obstruction functional multiple air fluid levels hyponatremia electrolytes should be taken care even potassium is also be cared
Diagnosis is ...large bowel obstruction. Mx....Ryles tube aspiration IV fluids Broad spectrum antibiotics Urine output monitoring ....if pt is stable do CECT abdomen....and further treatment depends on CT report.
All obstructions will be treated with IV fluids and electrolyte correction. Occasionally, a nasogastric tube is placed to remove fluid and gas backing up in the upper digestive tract. Medications are used to help with nausea and severe pain. A complete obstruction may require surgery or stenting.
Intestinal obstruction. Could be feces. Stool softener. Antacid, laxative or enema. Next ca rectum to be ruled out.
Hard stool or fecolith Suppository to soften stool Laxative or glycerin enema
SUGGESTIVE OF ACUTE INTESTINAL OBSTRUCTION
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