Step 2

Gastrointestinal 9

A 47 year-old woman comes to the emergency department because of a two-day history of abdominal cramps and vomiting. She reports not passing stool or flatus during this time. She has no history of similar symptoms. She underwent an abdominal hysterectomy 12 years ago. Past medical history is otherwise unremarkable, and she does not take any medications. Her temperature is 37.7°C (99.8°F), pulse is 106/min, respirations are 18/min, and blood pressure is 134/68 mm Hg. On physical examination, auscultation of the abdomen reveals hyperactive, tinkling, high-pitched bowel sounds. Palpation of the abdomen shows distention and mild tenderness but no guarding or rebound. The rest of the physical examination is unremarkable except for mild tachycardia. Laboratory studies reveal the following:

  • Hematocrit 42%
  • Leukocyte count 11,500/mm3
  • Serum
  • Sodium 140 mEq/L
  • Chloride 101 mEq/L
  • Potassium 3.6 mEq/L
  • Bicarbonate 28 mEq/L
  • Urea nitrogen 40 mg/dL
  • Glucose 110 mg/dL
  • Creatinine 1.7 mg/dL

Which of the following is the most likely diagnosis?

  • A) Acute cholecystitis
  • B) Colon cancer
  • C) Complete small bowel obstruction
  • D) Ileus secondary to renal failure
  • E) Perforated viscus


Alexandra Conway


Dr. Ted O'Connell

Last updated

Jun 09, 2024


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