shifting dullness IN RLQ
Auscultation
noisy and is heard as rushes. During attacks of colic ,the
sounds become loud ,highpitched and metallic .
Rectal examination:
2).The onset and character of vomiting.
Recurrent vomiting of bile-stained fluid
Prolonged nausea precedes vomiting, feculent.
Contispation and obstipation
肠梗阻病例讨论
CASE 1
A 60-year-old female is admitted to the emergency room with a 48- hour history of lower abdominal pain, nausea, vomiting and constipation. The patient describes the pain as crampy in early and notes that her abdomen has become distended over the last 12 hours. Her last bowel movement was three days prior to presentation.
Low rectal carcinoma and intussuscepted segment don’t be palpated
rectal exam reveals no stool in the rectum.
Knee-elbow Position
Admitting laboratory data
Develop later in the course of the obstruction little by little
Physical Examination
Inspection Palpation Percussion Auscultation
Inspection
right upper quadrant
X-rays
Upright
2008-12-4
2008-12-5
X-rays
Supine
2008-12-4
2008-12-5
CT scan
B-UltraSound
right lower quadrant
left upper quadrant
Left lower quadrant
Palpation
mild tenderness in RLQ but no guarding or rebound
Mass 5cmX4cm，
No peritonitis
Percussion
Physical exam reveals a temperature of 38℃. Her abdomen is distended.
Clinical Manifestations
Abdominal pain Nausea and vomiting
Obstipation Distention
A hemoglobin of 16, hematocrit 48, white blood cell count 12,200 with 74 polys.
Serum electrolytes show the level of serum sodium and potassium is 130mol/l and 3.0mol/l. Arterial blood gas analysis reveals that the result of PH is 7.30.
Abdominal pain
Colicky abdominal pain in early period lasting abdominal pain later
Nausea and vomiting
1).The nature of the vomitus. undigesபைடு நூலகம்ed food particles. becomes bilious. feculent.
Doctor need to answer:
Diagnosis Etiology Treatment
What should be done next?
Her past medical history is remarkable in that she underwent an appendectomy for acute appenditis ten years ago. She is otherwise healthy and takes no medications.
The onset of obstipation, a late development
Still pass flatus: the distal, unobstructed intestine empties. partial or incomplete obstruction
Distention
女性，60岁，“腹痛、呕吐、腹胀 和肛门停止排便排气2天,加重12小 时” 急诊入院
Question
1.what’s wrong with the old woman? 2.what causes it?
3.How can she get well?
Operation is need or not?
An abdominal X-RAY reveals multiple dilated loops of small bowel with numerous air-fluid levels. There is no gas or stool visible in the colon
Radiological Examinations