General Diagnosis and Management of Bowel Obstruction

Running head: GENERAL DIAGNOSIS AND MANAGEMENT OF BOWEL OBSTRUCTION
General Diagnosis and Management of Bowel Obstruction
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GENERAL DIAGNOSIS AND MANAGEMENT OF BOWEL OBSTRUCTION
Introduction
Background of the case study
The patient, a 73-year old woman, has been reported with abdominal pain and vomiting
at the emergency clinic. Abdominal X-ray confirmed that multiple loops of bowel have been
found in her intestines. Further detailing of the medical investigation showed that the woman had
undergone appendectomy and hysterectomy a long time back. Abdominal X-ray shows that
intestinal obstruction may be present for which the patient is suffering severely. These symptoms
have been common among the population. This clinical condition is treatable with efficient
management, provided early diagnosis and medical care is given. Abdominal pain accompanied
by vomiting is the most common among emergency admissions of patients. Abdominal pain and
vomiting are associated with a variety of pathologies; therefore a more comprehensive and
elaborate approach is to be taken to accurately determine the cause and related pathology [1].
Multiple diagnoses involving laboratory tests need to be performed.
Initial Management
The old woman has been admitted at the emergency hour, symptoms being severe.
Vomiting has resulted in an excessive fluid loss from her body. Conservative therapy or non-
operative therapy should be the first choice of approach. Care should be taken so that the patient
does not suffer from dehydration; in response to excessive vomiting, immediate intravenous fluid
therapy needs to be given to replenish for fluid loss, thereby promoting rehydration. Medication
should be allowed to reduce the severe abdominal pain. Dilated loops of the bowel as confirmed
by abdominal X-ray suggests intestinal bowel obstruction as a probable pathology. To address
this, intestinal volume and electrolyte balance need to be restored through intubation methods

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GENERAL DIAGNOSIS AND MANAGEMENT OF BOWEL OBSTRUCTION
[3]. Blood samples should be taken for biochemical and microbiological, cross-matching testing
before intravenous fluid therapy. Saline should be provided immediately to recover from the
effects of excessive vomiting. Nasogastric tubes need to be inserted to allow food intake. Various
water-soluble contrast agents like gastrograffin need to be administered, to determine the need
for surgery. Gastrograffin administration promotes water movement through the bowel, thereby
enhancing the peristaltic motility [4].
Differential Diagnosis
Diagnosis of small bowel syndrome is done based on the clinical presentation of the
patient. There is no morbidity related to the appendix as she had already undergone an
appendectomy. Initial diagnosis involves a plain radiograph of the abdomen. Plain abdominal
radiography is performed in the supine position. It shows the presence of multiple jejunal loops
of bowel which are lacking air passages. The distended diameters of the loops are determined in
this diagnostic method. Radiographic data can be negative or inconclusive if the obstruction is
acute. In that case, Ultrasonography or Computed Tomographic scan is performed to confirm the
diagnosis. Accurate clinical decision-making is based on initial diagnostic measures [2]. Blood
tests are performed which show changes in electrolytic balance and increase in white blood cells.
Ultra Sonography is another cross-sectional imaging technique, commonly employed for
diagnosis of intestinal obstruction if radiographic diagnosis indicates the severity of obstruction.
The location and pattern of obstruction of distended loops are clearly determined through
Sonography. Low grade and high grade bowel obstruction are confirmed through sonography
and CT scan. Multidetector Computed Tomography (CT) scan is a fast evaluation measure for
diagnosis of bowel obstruction. The level of obstruction of the jejunal loops in the intestine and
their associated complications, if any, are determined effectively through CT scan [3]. CT scan is