"Rule out SBO"

Case

Chief Complaint: “Rule out SBO”

History of Present Illness: A 52-year-old male was sent from his correctional facility for evaluation of small bowel obstruction after complaining of one day of acute onset severe abdominal pain. He endorsed nausea, vomiting, anorexia, polyuria and polydipsia but denied fevers, diarrhea, recent travel, sick contacts or unusual foods. His last bowel movement was two days prior to presentation but he was still passing flatus.

  • Medical Hx: denies
  • Surgical Hx: appendectomy
  • Review of Systems: otherwise negative
  • Social history: denies alcohol or drug use

Physical Exam

  • Vital Signs: T 99.5F BP 107/57  P 109  RR 18 O2 Sat 98-100% Pain 10/10
  • Gen: Apparent discomfort while clutching stomach
  • HEENT: EOMI, dry mucous membranes, full ROM neck
  • Lung: CTAB, symmetric chest rise, no respiratory distress
  • Cardiac: RRR, nl S1/S2, no m/r/g
  • Abdomen: Nondistended with healed surgical scar in right lower quadrant, + BS, diffuse mild tenderness to palpation, no organomegaly

Labs

Hematology
WBC 13.8 Hematocrit 30.2 Platelet count 229
INR 1.3 PT 13 APTT 32
Chemistry Panel
Sodium 114 Potassium 3.8 Chloride 78
Bicarbonate 24 BUN 14 Cr 0.3
Glucose 280 Calcium 10.2 Serum Osm 290
Abdominal Labs
AST 22 ALT 49 AlkP 68
Total protein 3.0 Albumin 5.3 Lipase 208

Peripheral serum studies were visually suggestive of the diagnosis (Figures 1 and 2).

Figure 1
Figure 1
Figure 2
Figure 2

RUQ Ultrasound: Unremarkable


Questions

  1. What is the bedside interpretation of the patient’s samples?
  2. What is the suspected diagnosis?


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