A patient presents to the emergency department with complaints of vomiting and abdominal pain. You note that the emesis contains bile
On physical examination, there is diffuse tenderness, abdominal distension, and rushing, high-pitched bowel sounds. Which of the following diagnoses would be most likely?
A. Gastric outlet obstruction
B. Small bowel obstruction
C. Distal intestinal blockage
D. Colonic obstruction
ANS: B
The contents of the vomitus commonly vary according to the level of obstruction. Gastric outlet obstruction is associated with emesis containing undigested food. Proximal small intestinal blockage is likely to be bile-stained. Distal intestinal blockage is more likely to contain fecal matter. The degree of cramping and pain is often related to the proximity of the obstruction, so that obstructions of the lower intestines may have less severe cramping, vomiting, and/or pain. Bowel sounds often are high pitched and metallic sounding but may later become absent. Tenderness may be localized or diffuse. Distention as well as a succussion splash may be present.
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