Question

38 yo woman with abdominal findings of distended, tympanitic and mildly tender throughout but w/o rebound or localized tenderness

pt has SBO and an NG was placed, correct fluid and electrotlyte abnormalities
you observe and do serial examinations and she has partial improvement with some flatus and one small bowel movement

when you remove the NG she becomes nauseated and distended

what is the next step

Answer 1

In a patient with small bowel obstruction, fluid and electrolyte abnormalities such as dehydration, hypokalemia, hyponatremia, and metabolic acidosis may occur. Serial examinations are important to monitor the patient's progress. If symptoms worsen after removal of the NG tube, further evaluation and possible surgical intervention may be necessary.

Step-by-step explanation:

The patient in this case has a small bowel obstruction (SBO) and has an NG (nasogastric) tube placed. The correct fluid and electrolyte abnormalities you may observe in a patient with SBO are dehydration, electrolyte imbalances such as low potassium (hypokalemia) and low sodium (hyponatremia), and metabolic acidosis. Serial examinations are important to monitor the patient's progress and to assess for any worsening symptoms. If the patient has partial improvement with some flatus and a small bowel movement, it indicates that the obstruction is resolving. However, when the NG tube is removed and the patient becomes nauseated and distended, it suggests the possibility of a recurrence of the obstruction. The next step would be to reevaluate the patient, possibly with imaging studies such as a CT scan, to determine the cause of the obstruction and to decide on further management, which may include surgical intervention.