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
Cases that would interest you
- Login to View the image
21 yr male, acute ( ? sub acute ) intestinal obstruction, CBC - (N), S.bili 3.19 D-0.88, RFT amylase lypase electrolytes - (N), relieved by conservative management , .... same episode 3 days before but relieved spontaneously ( didn't admitted him)......what is further work up to r/o causes ???......surgical opinion please.....
Dr. Adesh Kale5 Likes23 Answers - Login to View the image
58 years old male having abdominal pain with distension, vomiting Please diagnose the case and suggest treatment
Dr. Jagannath Sahasrabudhe1 Like30 Answers - Login to View the image
A 76 years female come to ER with complaints of abdominal pain, nausea and intermittent diarrhea since two days. Apparently, she usually has constipation for which she takes laxative. She doesn't have any significant medical problems like Diabetes, HTN or Hypothyroidism. CT scan reveal characteristic finding. Diagnosis and management.
Dr. Mohammed Parvez5 Likes12 Answers - Login to View the image
Young male patient, not an alcoholic.. H/o repeated vomiting and loose stools since 3 days..no history of any surgery in the past .. Diagnosis and Mx
Dr. Sushilkumar Sawant0 Like11 Answers - Login to View the image
Latest Posts Bio 16 Amazing Benefits Of Bael Juice For Skin, Hair Vitiligo Diet – What Is It And How Does It Help 7 Amazing Health Benefits Of Nance Fruits 19 Significant Benefits Of Mangosteen (Mangustan) How To Make Jamun Vinegar And What Are Its 38 Benefits Of Lime (Kaccha Nimbu) For 10 Amazing Benefits Of Bael (Kaitha) Bael, also known as the “Wood Apple”, is a species native to India. The bael tree is considered to be sacred to the Hindus. A famous drink known as sherbet is made from the bael fruit and it has been known for its medicinal values since 2000 BC. Here in this post you will know about various benefits of bael fruit. The local names of bael fruit are ‘ Kaitha‘ in Hindi, ‘Maredu Pandu‘ in Telugu, ‘Vilam Palam ‘ in Tamil, ‘ Belada Hannu ‘ in Kannada, ‘Koovalam‘ in Malayalam, ‘Kothu ‘ in Gujarati, ‘Kavath ‘ in Marathi and ‘Koth Bel ‘ in Bengali. Health Benefits of Bael Fruit: The Beal fruit benefits are mentioned below. 1. Can cure diarrhoea, cholera, haemorrhoids, vitiligo: The presence of tannin in the bael fruit helps in curing diseases like diarrhoea and cholera. The dried powder of the fruit is used to treat chronic diarrhoea. The extract of unripe bael fruit can effectively treat haemorrhoids and vitiligo. It is also used to treat anaemia, ear and eye disorders. In ancient days, the dried powder of raw bael mixed with turmeric and ghee was applied on fractured bones to treat fracture. [Read: Vitiligo Treatment ] 2. Reduces gastric ulcer: Bael has certain phenolic compounds containing anti-oxidants that help in fighting gastric ulcers, particularly, gastroduodenal ulcers. This type of ulcer is caused due to the imbalance in the acidic level in the stomach. [ Read: Nutmeg Benefits ] 3. Antimicrobial property: Researchers have proved that the extract of bael fruit has antimicrobial functions. It also has anti viral and anti fungal properties that help in treating various infections in the body. 4. Can cure scurvy: Scurvy disease is caused due to the deficiency of vitamin C and this effects the blood vessels. Bael being a rich source of vitamins is capable of curing this disease when added to the diet. By J.M.Garg (Own work) [GFDL or CC-BY-SA-3.0 ], via Wikimedia Commons 5. Can control cholesterol: The extract of bael leaf can be used to control the cholesterol level in blood which makes the bael leaves highly therapeutic too. [ Read: Tamarind Benefits ] 6. Can solve respiratory problems: The oil extracts from bael can be used to cure respiratory disorders like asthma or cold. This oil can also provide resistance to cold when applied on the scalp before a head bath. 7. Anti-inflammatory: Inflammation can be quickly cured when the extract of bael is applied on the inflamed region. [ Read: Cabbage Health Benefits ] 8. Can be used to treat heart diseases: The juice of ripe bael fruit when mixed with ghee and added to daily diet prevents heart diseases. This is a traditional method which has been used for ages to treat diseases like heart strokes and attacks. 9. Can prevent constipation: Bael fruit is said to be the best natural medicine to cure constipation. Adding small amount of black pepper and salt to the pulp and consuming it regularly removes toxins from the intestines. It can also be taken in the form of sherbet to cure constipation. [ Read: Benefits of Brinjal ] 10. Can control diabetes: Bael is rich in laxatives which makes it useful in controlling the blood sugar levels. This is because it energizes the pancreas and makes it produce enough amount of insulin which is necessary to control sugar level in the blood. Nutritional Value of Bael Fruit The various nutrients in a bael fruit per 100gm. NUTRIENTS AMOUNT Carbohydrate 31.8 gm Fat 0.3 g Proteins 1.8 gm. VITAMINS Vitamin A 55 mg. Vitamin B Rich in Vitamin B1 and B2 Vitamin C 60 mg. Thiamine 0.13 mg. Riboflavin 1.19 mg. Niacin 1.1 mg. Carotene 55 mg. MINERALS Calcium 85 mg. Potassium 600 mg. Fiber 2.9 gm. Water 61.5 g. Energy 137 k.cal Energy 137 k.cal Caution 1. Too much bael consumption can cause stomach upsets and constipation 2. Bael can be harmful for pregnant women. Avoid bael
Dr. Tapan Kumar Sau7 Likes10 Answers
1 Like