A nurse practitioner reports that your patient's abdominal x-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in:
A. Appendicitis
B. Cholecystitis
C. Bowel obstruction
D. Diverticulitis
ANS: C
The most common causes of mechanical obstruction are adhesions, almost exclusively in patients with previous abdominal surgery, hernias, tumors, volvulus, inflammatory bowel disease (Crohn's disease, colitis), Hirschsprung's disease, fecal impaction, and radiation enteritis. Initially, the patient complains of a cramping periumbilical pain that eventually becomes constant. Physical examination reveals mild, diffuse tenderness without peritoneal signs, and possibly visible peristaltic waves. In early obstruction, tinkles, rushes, and borborygmi can be heard. In late obstruction, bowel sounds may be absent. The diagnosis can be made with flat and upright abdominal films looking for bowel distension and the presence of multiple air-fluid levels. CT or MRI may be necessary for confirmation.
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