gastrointestinal disorders/volvulus

Lab Parameter	Value	Reference Range
White Blood Cell (WBC) count	18.5 x 10^9/L	4.0-10.0 x 10^9/L
Hemoglobin	14.2 g/dL	13.5-17.5 g/dL
Hematocrit	43.5%	41-53%
Sodium	132 mEq/L	135-145 mEq/L
Potassium	3.0 mEq/L	3.5-5.0 mEq/L
Blood Urea Nitrogen (BUN)	35 mg/dL	7-20 mg/dL
Creatinine	1.8 mg/dL	0.6-1.2 mg/dL
Lactate	3.8 mmol/L	0.5-2.2 mmol/L

Lab Parameter

Value

Reference Range

White Blood Cell (WBC) count

18.5 x 10^9/L

4.0-10.0 x 10^9/L

Hemoglobin

14.2 g/dL

13.5-17.5 g/dL

Hematocrit

43.5%

41-53%

Sodium

132 mEq/L

135-145 mEq/L

Potassium

3.0 mEq/L

3.5-5.0 mEq/L

Blood Urea Nitrogen (BUN)

35 mg/dL

7-20 mg/dL

Creatinine

1.8 mg/dL

0.6-1.2 mg/dL

Lactate

3.8 mmol/L

0.5-2.2 mmol/L

See Explanation

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Question 2 / 2

683d163ec1b3f4bd827dacc4

Surgery

gastrointestinal disorders

volvulus

Case History

A 78-year-old male residing in a long-term care facility is brought to the emergency department by staff due to a sudden onset of severe, colicky abdominal pain and progressive abdominal distension over the past 24 hours. His medical history includes Parkinson's disease, which has led to chronic constipation and limited mobility. He has not had a bowel movement or passed flatus since the onset of pain. On examination, his abdomen is markedly distended, tympanitic, and diffusely tender to palpation, particularly in the left lower quadrant, but without rebound or guarding. Bowel sounds are diminished. His temperature is 98.6°F (37.0°C), heart rate is 78 bpm, blood pressure is 125/75 mmHg, and respiratory rate is 16 breaths/min. An initial upright abdominal radiograph reveals a significantly dilated, omega-loop shaped colon occupying most of the abdomen, consistent with a "bent inner tube" appearance. Given these findings, what is the most probable diagnosis and the immediate, most appropriate initial management strategy for this patient?

Lab Parameter	Value	Reference Range
Lactate	2.1 mmol/L	0.5-2.5
White Blood Cell Count (WBC)	8.5 x 10^9/L	4.0-11.0
Hemoglobin	14.2 g/dL	13.5-17.5
Sodium	140 mmol/L	135-145
Potassium	4.1 mmol/L	3.5-5.0

A ) Diagnosis: Severe Fecal Impaction; Management: Manual disimpaction and serial enemas.

B ) Diagnosis: Sigmoid Volvulus; Management: Urgent flexible sigmoidoscopy for endoscopic detorsion.

C ) Diagnosis: Sigmoid Volvulus with bowel ischemia; Management: Immediate exploratory laparotomy with bowel resection.

D ) Diagnosis: Large Bowel Obstruction; Management: CT abdomen/pelvis to identify the obstruction cause.

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