Investigating Abdominal Pain, Distension, and Constipation
The patient's symptoms—abdominal pain, distension, and absolute constipation—are classic indicators of a potential bowel obstruction.
Choosing the Right Investigation
The primary goal is to confirm the obstruction and potentially identify its location and cause quickly.
- Plain X-ray abdomen (Erect) is the investigation of choice in this acute scenario.
Rationale for Choice
An erect abdominal X-ray is preferred because:
- It can effectively demonstrate signs of obstruction, such as dilated loops of bowel and characteristic air-fluid levels. The erect position helps distinguish between gas and fluid.
- It is a rapid, accessible, and relatively low-risk initial diagnostic tool.
- It helps differentiate between small bowel obstruction (SBO) and large bowel obstruction (LBO).
Evaluating Other Options
Other investigations are less suitable as the *initial* choice:
- Ultrasonography: May show dilated bowel but is less sensitive and specific for confirming obstruction compared to X-ray or CT, especially for determining the exact level.
- Barium meal follow-through: Generally contraindicated in suspected acute obstruction. Barium contrast can worsen the blockage and complicate surgical management if needed.
- Colonoscopy: Primarily examines the colon. It is not suitable for diagnosing obstruction in the small bowel, which is a common cause of these symptoms. It is also invasive and not the first step for acute presentation.
Therefore, the plain erect abdominal X-ray provides the most appropriate and immediate diagnostic information for suspected bowel obstruction.
Important Questions from Intestines
- An eight month old male child is brought to the emergency with recurrent episodes of screaming and drawing up of legs. The child appears to be listless in between the attacks. Local examination of abdomen reveals feeling of emptiness in the right iliac fossa and blood stained mucus is found on the finger on per rectal examination. The most probable clinical diagnosis in this child is
Which of the following statements regarding Ogilvie's syndrome are correct?
1. It presents as acute large bowel mechanical obstruction
2. Marked caecal dilatation is a common feature on X-ray abdo- men
3. Caecal perforation is a well recog- nized complication of this condi- tion
4. Intravenous Neostigmine is used for the treatment of this condition
Select the correct answer using the code given below :
In familial adenomatous polyposis, which of the following all are true ?
1. Presence of $>100$ colorectal polyps
2. Positive family history
3. Autosomal Recessive inheritance
4. Genetic mutation on Chromo- some 5
Select the correct answer using the code given below :
- Among the extra intestinal manifesta- tions of Crohn's disease which one of the following is related to the disease activity?
Which of the following statements with regard to Enteric perforation are correct?
1. Salmonella typhi is the causative organism for Enteric fever
2. Enteric perforation characteristi- cally occurs during third week of illness
3. Typhoid ulcers are placed trans- versely to the long axis of the gut
4. Terminal ileum is the most common site for enteric perfora- tion
Select the correct answer using the code given below :
