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February 2006 Radiology Answer Key

February 2006 Radiology Quiz

 Answers due March 1st, 2007

             This is a patient is a 28 year old female presents to the ED with the complaint of abdominal pain. The patient has a history of foreign body ingestions in the past.  The following x rays are shown.

Questions:

1. Describe what you see?

    • Supine film: Dilated small bowel loops centrally with decompression of colon
    • Erect film: Air-fluid levels in stomach and dilated small bowel loops

      • Diagnosis: Small Bowl Obstruction

2. How do these patients typically present?

    • Abdominal pain
    • Nausea
    • Vomiting, which is associated more with proximal obstructions
    • Diarrhea (an early finding)
    • Constipation (a late finding) as evidenced by the absence of flatus or bowel movements
    • Fever and tachycardia - Occur late and may be associated with strangulation

3. What are the causes for the above diagnosis?

    • The most common cause of SBO is postsurgical adhesions.
    • Other etiologies of SBO include malignant tumor (20%), hernia (10%), inflammatory bowel disease (5%), volvulus (3%), and miscellaneous causes (2%).

4. What would be the management for this patient?

    • Initial ED treatment consists of aggressive fluid resuscitation, bowel decompression, administration of analgesia and antiemetic as indicated clinically, antibiotics, and early surgical consult.

 Beatles Trivia: Which album features Paul sitting in a trunk with the other three Beatles surrounding him?

    • Answer: The Beatles Yesterday...and Today.

    If you turn the album on its side it resembles a coffin, with Paul in it! With the somber look on all of their faces, could they be mourning the death of their bandmate?

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