Differentials
Ileus
SIGNS / SYMPTOMS
Less crampy abdominal pain; often associated with another cause (e.g., postoperative, systemic infection, drugs).
INVESTIGATIONS
CT scan shows passage of contrast throughout the small bowel and into the large bowel. No transition point identified.
Infectious gastroenteritis
SIGNS / SYMPTOMS
Vomiting, typically nonbilious.
INVESTIGATIONS
X-ray shows gas throughout abdomen; stool cultures may be positive for viruses or bacteria.
Large bowel obstruction
SIGNS / SYMPTOMS
Very distended abdomen; constipation progressing to absolute constipation.
INVESTIGATIONS
CT may visualize obstruction, perforation, dilatation, ischemia, malignancy.
Intestinal pseudo-obstruction
SIGNS / SYMPTOMS
Chronic condition; constipation; often associated with administration of neurologic drugs (e.g., amitriptyline, imipramine). Rarely, clozapine has been associated with pseudo-obstruction.[28]
INVESTIGATIONS
X-ray and CT may show dilated small or large bowel, which may be massively dilated.
Appendicitis
SIGNS / SYMPTOMS
Pain in right lower quadrant with nausea; vomiting (nonbilious).
INVESTIGATIONS
Ultrasound and CT may confirm diagnosis in most cases.
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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