Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Bowel Obstruction

Evaluate breaches in the standard of care to determine a Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Bowel Obstruction

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Abdominal distention
    Vomiting
    Crampy abdominal pain
    New onset constipation
    None of the above
    Symptoms not elicited
    Answer unknown
    Why is this important?
    Symptoms of bowel obstruction: • Abdominal distention • Vomiting • Crampy abdominal pain • Inability to pass flatus • Inability to pass stool
    (2011) 29 EMDCNA 2 319

  • Was a medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's examination, enables the clinician to make educated evaluations, and be better equipped to advise the patient.
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  • With which of the following risk factors did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    The most frequent causes of small bowel obstruction are post-operative adhesions and hernias that cause extrinsic compression of the intestine. Less frequently, tumors or strictures of the small bowel can cause intrinsic blockage. Patients with Crohn's disease frequently present with obstruction due to stricture.
    (2011) 29 EMDCNA 2 319

  • With which of the following physical signs did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    Fever, increased pulse rate and low blood pressure are indicative of complications associated with bowel obstruction.
    (2011) 29 EMDCNA 2 319

  • With which of the following signs of dehydration did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    The hallmark sign of small bowel obstruction is dehydration and all its sequealae.
    (2011) 29 EMDCNA 2 319

  • Was a physical examination performed? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.
    Click here for additional information at ClinicalKey.com

  • Which of the following diagnostic laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    A thorough physical examination is required for all patients suspected to have a bowel obstruction. Examination of any existing hernial sites and a rectal examination all lead to the diagnosis.
    (2011) 29 EMDCNA 2 319

  • Which of the following diagnostic imaging studies were performed?(Choose all that apply) Why is this important?
    Answer this question
    Laboratory studies are generally not helpful in determining the presence of small bowel obstruction, but can help in the assessment of the degree of dehydration.
    (2011) 29 EMDCNA 2 319

  • Was the patient discharged and later found to have a bowel obstruction? Why is this important?
    Answer this question
    Early emergent surgical consultation must be obtained when mechanical obstruction is suspected based on the history, physical examination findings, and imaging study results, particularly if there is potential for a complicated SBO. Many disorders present with some, if not all, of the signs and symptoms of SBO, notably nausea, vomiting, and abdominal tenderness. Some of these conditions may themselves underlie development of mechanical or non mechanical bowel obstruction.
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  • To which of the following was the patient referred? Why is this important?
    Answer this question
    Diagnostic imaging studies are required to make a definitive diagnosis.
    (2011) 29 EMDCNA 2 319

  • Was the patient hospitalized? Why is this important?
    Answer this question
    A bowel obstruction may lead to bloating, pain, bleeding or perforation. Upon diagnosis, consultation with a gastroenterologist is necessary.
    (2011) 29 EMDCNA 2 319

  • Were antibiotics administered to the patient? Why is this important?
    Answer this question
    Surgical management may be necessary, dependant upon the source of the obstruction.
    (2011) 29 EMDCNA 2 319

  • With what type of bowel obstruction was the patient diagnosed? (Choose all that apply) Why is this important?
    Answer this question
    Intestinal obstruction may be categorized according to the site of obstruction and the extent of the obstruction: Small bowel obstruction(SBO)or large bowel obstruction (LBO).
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  • Which of the following treatment options was suggested? Why is this important?
    Answer this question
    Conservative management includes intravenous resuscitation, decompression, and bowel rest. Rehydration is essential, because liters of gastrointestinal secretions can accumulate during an obstructive episode. Nasogastric tube decompression remains a mainstay of therapy, with no added benefit from long intestinal tubes.
    (2011) 29 EMDCNA 2 319-345

  • Which of the following surgical approaches was utilized? Why is this important?
    Answer this question
    Surgical excision of an obstructive lesion and assessment of bowel viability are mandatory for all cases of suspected bowel strangulation. Laparoscopic treatment of small bowel obstruction appears to be appropriate for carefully selected patients.
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  • Which of the following post-operative complications did the patient develop?(Choose all that apply) Why is this important?
    Answer this question
    The most common medical complications include pneumonia and respiratory failure, pulmonary embolism, cardiac complications, and prolonged ileus. The most common surgical complications are wound infections, intra-abdominal infections, intra-abdominal bleeding, and intestinal necrosis and perforation.
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  • Were patient education/discharge instructions provided? Why is this important?
    Answer this question
    Patients should be instructed to return for nausea, vomiting, abdominal distension, constipation and obstipation.
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  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
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  • What type of large bowel obstruction did the patient have? Why is this important?
    Answer this question
    Large bowel obstruction can be divided into four types according to treatment options: mechanical obstruction as a result of cancer, sigmoid volvulus, cecal volvulus and pseudo-obstruction.
    Click here for additional information at ClinicalKey.com