Question 205 · LEK · Bowel obstruction
A female patient, 65 years of age, came to see her family doctor because of severe abdominal pain which has become more intense for the last few days. Over the last few months she has had alternating constipation and diarrhoea. Presently, she has had no bowel movement for a few days. Medical history revealed iron-deficiency anaemia diagnosed a few months before and arterial hypertension which has been poorly controlled as the patient is not fond of going to the doctor and she did not have any health complaints. On physical examination, the abdomen was distended and painful to touch, and increased intestinal peristalsis could be heard. Deep palpation was not possible due to abdominal tension. Indicate appropriate measures to be taken:
- A. urgently refer the patient to hospital because of suspected intestinal obstruction.
- B. refer the patient to hospital for elective abdominal diagnostics.
- C. refer the patient to an outpatient clinic for abdominal X-ray in a standing position, to exclude intestinal obstruction.
- D. refer the patient for laboratory blood tests for diagnostics of anaemia.
- E. asking the patient to take simethicone preparation and come for a control visit after the bloating recedes.
Hint
A distended, tense, tender abdomen with loud peristalsis and no stool is an emergency, not an outpatient work-up.
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