Mrs H. is a 40 year old woman who presents to the ED with acute abdominal pain. The pain is of a colicky nature and central. She states the pain occasionally goes into her back.

On Examination

She has vomited several times today and the last time she noticed green coloured vomit but no blood. She states that she doesn't think she has opened her bowels or passed flatus for maybe 2 days. She has a previous medical history of appendectomy.

  • BP – 120/80

  • HR – 110

  • RR – 25

  • Sats – 98% RA

  • Na – 130

  • K – 2.6

  • Urea – 12.9

  • Creatinine – 80

The admitting doctor orders an abdominal x-ray (see below):

Image credit: Life in the Fastlane

Image credit: Life in the Fastlane


Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. Name the abnormalities in the x-ray.

  2. What are the 4 most likely causes?

  3. Comment on the blood results and explain the biochemical abnormalities.

  4. Outline your strategy for fluid management in this patient.

  5. Give other causes for the urea and creatinine discrepancies not related to this case.

  6. How would the AXR differ in large bowel obstruction?

  7. What would be the subsequent management of this patient after initial fluid resuscitation?