Question

An 88yr old woman is receiving long-term care in nursing home and is brought to ED with history of constipation and recent deterioration in mental status. Her BP is 100/60, HR 120. she has abdominal distension and moans when you examine her abdomen. Rectal exam reveals no stool. How would you evaluate and manage this patient?

Answer 1

Constipation and recent deterioration in mental status in an elderly patient can indicate a bowel obstruction, which would require evaluation and management. Additional tests, imaging studies, and consultation with specialists may be necessary. Management may involve conservative measures or surgical intervention.

Step-by-step explanation:

Constipation and recent deterioration in mental status in an elderly patient can be concerning and may require evaluation and management. In this case, the patient's symptoms, such as abdominal distension and moaning with abdominal examination, suggest a possible bowel obstruction. The absence of stool on rectal exam further supports this suspicion.

To evaluate the patient, additional tests may be necessary, including laboratory tests such as complete blood count (CBC) and electrolyte panel, imaging studies like abdominal X-ray or CT scan, and possibly a consultation with a gastroenterologist or general surgeon. Management of a bowel obstruction may involve conservative measures like bowel rest, hydration, and medications for symptom relief, or it may require surgical intervention.