Constipation causing abdominal mass Intestinal obstruction Diverticulitis Irritable bowel syndrome
Mrs. Park’s bowel sounds are normoactive in all quadrants, with bruits or friction sounds. Scattered dullness in LLQ during percussion is suggestive of feces in the colon; otherwise, her abdomen is tympanic. Her abdomen is soft to palpation; mild guarding and oblong mass suggesting feces were discovered in LLQ. No CVA tenderness; liver span 7 cm @ MCL; no splenic dullness. Digital rectal exam revealed a fecal mass in the rectal v No abnormalities were noted during the pelvic exam, so pelvic inflammatory disease is not suspected. Ms. Park’s urinalysis was normal, which rules out a urinary tract infection. No signs of dehydration or cardiovascular abnormalities. Mrs. Park’s sympto and health history suggest she has constipation. Differential diagnoses are constipation, diverticulitis, and intestinal obstructi
Plan
stool for occult blood CBC/ ESR with CRP Metabolic panel serum amylase abdominal sonogram or abdominal x-ray for to locate mass; Bowel rest if diverticulitis : if neg: increase po fluids, increase fiber, increase activity as tolerated. Creating a bowel regimen is encouraged.
Mrs. Park should receive diagnostic tests to rule out differentials CBC to assess for elevated WBCs associated with diverticulitis, electrolyte profile to evaluate electrolyte and fluid status, and a C scan to assess for obstruction. If Mrs. Park has diverticulitis I recommend IV fluids and bowel rest. If she has bowel obstructio recommend NPO, IV fluids, and general surgical consult. If she h constipation, I recommend that she increase fluids, increase fibe and increase activity as tolerated.
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