Digestive Case Study 7: Small-Bowel Obstruction*

 

A 57-year-old man with severe abdominal pain is evacuated from a cruise ship and presents to a local emergency department (ED).

 

The pain, which is most severe in the right lower portion of his abdomen, started soon after he boarded the cruise ship 2 days before presentation. Since onset, the pain has worsened, and the patient has noticed his abdomen becoming progressively "bloated." The pain is associated with nausea and vomiting, and the patient has not been able to have a bowel movement. On further questioning, he reports having night sweats, low-grade fevers, intermittent abdominal discomfort with constipation, and a 30-lb weight loss over the past 2-3 months. He has no significant medical history, is not taking any medications, and is not on any weight-loss regimen. He does have a significant family history of colon cancer, soft tissue sarcoma, pancreatic cancer, chronic myeloid leukemia (CML), and prostate cancer.

 

 

 

An abdominal computed tomography (CT) scan (see Figure 1) demonstrates a large mass in the patient's RLQ.

 

 

 

QUESTIONS:

 

1.) Describe the mechanical and biochemical processes of digestion.  Indicate where each takes place.

 

 

2.) Describe the functions of the following components of gastric juice.

a.         Hydrochloric acid

b.         Pepsinogen

c.         Pepsin

d.             Intrinsic factor

 

3.) What role does the pancreas play in digestion and blood sugar maintenance?  Discuss in terms of both enzyme and hormone action.

 

4.) Elaborate more fully on the functions of the Small and  Large Intestine

 

5.) What does the physical exam tell you?  Include a discussion of the patients’ “pain” and “bloating”.  What do the Laboratory results tell you? (this is the focus of this case study, don’t just re-state the results)

 

6.) What is the likely etiology(cause or set of causes) leading to this small bowel obstruction?

               (Hint: Note the patient's strong family history of cancer.)

           

7.) What course of treatments would you recommend? Offer at least 3 options

 

*presentation adapted from emedicine online