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Intestinal bowel obstruction case .pptx
- 1. CASE STUDY INTESTINAL BOWEL OBSTRUCTION PRESENTED TO :- Dr. KENZHEBEK PRESENTED BY :- ASIF AHMED
- 2. Case :Thai male, 73 years old CC : Lower abdominal pain , abdominal distension 10 hrs. PTA Nausea, vomiting with gastric content 4 times CASE
- 3. Present illness 2 days PTA o Lower abdominal pain o sharp pain, no referred pain, severe pain alternate with mild pain o pain was not related with position o pain had slightly increase and happened all time
- 4. Duration of heavy pain is 5-10 minutes per time o Interval of pain is 1 hr. pain score 8/10 o Nausea, no vomiting ,anorexia o Medication : antipyretic and analgesic Patient defecated 2 times in 2 days first time, it look like bullet, no mucus and blood second time, it is watery diarrhea flatus
- 5. Past history 10 months PTA (12/9/56) He went to Kazakhstan hospital o suspected gut obstruction o explore laparotomy with decompression o no obvious cause of obstruction o Final Diagnosis bowel ileus Underlying disease: COPD poor control, diagnosed at "Nhong seur" hospital no allergy of food and drug no alcoholic History of nipa palm 10-20 rolls/day 20 years now quit 1 month no malignancy
- 6. Physical examination • V/S : BP 113/68 BT 36.5 PR 128 RR 20 • GA : a Thai elderly male, good consciousness, not pale , no jaundice, no cyanosis • HEENT : no pale conjunctiva, anicteric sclera, no dry lip, no dry tongue, no lymphad • CVS : normal S1S2 ,no murmurs RS :increase AP diameter, poor air entry, no tachypnea, normal breath sound, no adventitious sound
- 7. • Abdominal : hypoactive bowel sound, abdominal distension, generalized tenderness, no guarding, no rebound tenderness, hypertympanic on percussion, no sign of chronic liver disease Surgical scar extremities : cap refill < 2sec, no pitting edema PR : no feces,no mass, no rectal shelf, normal sphincter tone
- 8. Lab investigation Complete blood count Hemoglobin 14.6 g/dL Hematocrit 42.7% White blood cell 12.29 x103 /mm3 Neutrophil 81.2% Lymphocyte 10.2% Platelet 407x103 /mm3 Electrolyte Sodium Chloride Potassium Bicarbonate 140 mmol/L 90 mmol/L 5.27 mmol/L 28.2 mmol/L BUN and Creatinine
- 9. Differential diagnosis: Bowel obstruction Bowel ileus Volvulus Enteritis
- 10. X-RAY Hollow organs : - Dilatation of small bowel - Air-fluid level : different height in the same loop pattern
- 11. CT WHOLE ABDOMEN
- 12. Conclusion: o abdominal pain and abdominal distension with history of laparotomy o Film acute abdomen series o Sign of small bowel obstruction o CT o Transition point was seen at small bowel
- 13. Final diagnosis
- 15. Treatment: Conservative treatment Surgical treatment o Explore laparotomy to lysis adhesion with decompression of small bowel
- 16. Primary Treatment Resuscitation Monitor : V/S , I/O , CVP , Oxygen saturation • NPO IV fluid , Nutrition NG with suction for decompression Foley catheter Medication(Antibiotics,Analgesics,Antiemetic, U/D Treatment)
- 17. Surgical Treatment Indication Dx: Complete small bowel obstruction Virgin abdomen Worsened of disease after conservative treatment Methods Explore Laparotomy Laparoscopic surgery
- 18. • Complication Bowel Strangulation Perforation Intra-abdominal abscess • Prevention (Adhesion barrier) Sodium hyluronate and Carboxymethylcellulose (Seprafilm®) Oxidized cellulose (Interceed®)