Differentials
Ileus
SIGNS / SYMPTOMS
Less cramping abdominal pain; often associated with another cause (e.g., postoperative, systemic infection, medications).
INVESTIGATIONS
CT scan shows passage of contrast throughout the small bowel and into the rectum.
Infectious gastroenteritis
SIGNS / SYMPTOMS
Vomiting, typically nonbilious. Diarrhoea.
INVESTIGATIONS
Abdominal CT scan will be negative for any intestinal obstruction; stool cultures may be positive for viruses or bacteria.
Large bowel obstruction
SIGNS / SYMPTOMS
Very distended abdomen; constipation progressing to absolute constipation.
INVESTIGATIONS
CT will reveal the level of obstruction in the bowel.
Intestinal pseudo-obstruction
SIGNS / SYMPTOMS
Chronic condition; constipation; often associated with administration of neurological medications (e.g., amitriptyline, imipramine). Rarely, clozapine has been associated with pseudo-obstruction.[39]
INVESTIGATIONS
X-ray and CT may show dilated small or large bowel, which may be massively dilated.
Acute appendicitis
SIGNS / SYMPTOMS
Pain in right lower quadrant with nausea; vomiting (nonbilious).
INVESTIGATIONS
Ultrasound and CT may confirm diagnosis in most cases.
Acute pancreatitis
SIGNS / SYMPTOMS
Continuous upper abdominal pain radiating through to the back; nonbilious vomiting.
INVESTIGATIONS
Increased amylase and lipase; CT scan shows inflamed pancreas.
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