CASE

PRESENTATION

GUT OBSTRUCTION

Presented by: Lakshita Taneja

Pharm D 5th year
(1850951009)
SUBJECTIVE
EVIDANCE
 DEMOGRAPHICS
Patient code 54355

AGE 17 years

SEX FEMALE

WEIGHT 42 Kg

BP 130 / 90 mmHg

PULSE RATE 70/ min

BODY TEMPERATURE 98.6 F

 COMPLAINTS ON ADMISSION

 Abdominal pain since 2 days

 Constipation since 2 days
 Vomiting since 2 days
 Sever pain in intestine and vomiting containing indigested food
 PATIENT HISTORY

Medication Drug name Frequency

T. Meftal spas Dicyclomine (10mg) + 500 mg TDS

Mefenamic Acid (250mg)
(Abdominal pain or
cramps)
T. Brufen Ibuprofen 200mg SOS
(Analgesic)

Syp. Cypcare Cyproheptadine Hydrochloride IP 7.5 ml/ hrly

2 mg. + Tricholine Citrate
(increases appetite)
Solution (65%) 275mg
OBJECTIVE
EVIDANCE
 BIOCHEMISTRY INVESTIGATION

PARAMETERS OBSERVED VALUE NORMAL RANGE

Hb 10.4 12 – 16 g/d L
RBC 4.20 4 – 6 g/d L
MCV 41.2 76 - 99 fLa
MCH 28.1 27 – 32 pg
MCHCH 30.8 31 – 35 %
Platelets 2.0 1.5 – 4.0 lakh/
cumm
WBC 8.3 x 10 4000 – 10000 cumm
Lymphocytes 21% 20 – 45 %
Neutrophils 69 .0 40 – 70 %
 BIOCHEMISTRY INVESTIGATION

PARAMETERS OBSERVED VALUE NORMAL RANGE

LIVER FUNCTION TEST
Serum Bilirubin 1.1 0.3 – 1.1 mg/ d L
(Total)
AST (SGOT) 20 5 – 40 IU/L
ALT (SGPT) 16 5 – 35 IU/L
ALP (Serum) 111 60 – 150 IU/L
RENAL FUNCTION TEST
Blood Urea 32 15 – 45 mg/ dL
Sr. Creatine 0.9 0.8 – 1.3 mg/ dL
 OTHER DIAGNOSTIC TEST

TEST

Abdomen Xray: Gut obstruction, gas and faecal

matter are seen in gut loops, multiple air fluid
level are seen in abdomen

Ultrasound: small free fluid is seen in peritoneal

cavity
ASSESSMENT
 DIAGNOSIS

On the basis of subjective and objective

evidence the patient was diagnosed
with:
 GUT OBSTRUCTION
PLAN
 MANAGEMENT PLAN

Management of uncomplicated obstructions includes fluid

resuscitation with correction of metabolic derangements,
intestinal decompression, and bowel rest
 TREATMENT CHART
DRUG INDICATION FREQUENCY /
STRENGTH
Inj. Ceftriaxone Antibiotic 1 g iv BD

Inj. Metronidazole Antibiotic 100 ml iv TDS

Inj. Pantoprazole PPI 40 mg iv BD

Inj. Diclofenac Anti- inflammatory 1 ml iv BD

Inj. Vit K Anti coagulant 500 ml 1M x 3 days
 DRUG-DRUG INTERACTION

DRUG DRUG EFFECT MANAGEMENT

Ceftriaxone Pantoprazole Increased risk Monitor the

of drug dose of drugs
induced to reduce the
arrhythmia effect

Ceftriaxone Diclofenac Significant Monitor the

rise in dose of
ceftriaxone medicine to
biliary reduce
excretion excretion of
ceftriaxone
 ADRs

DRUG ADR
Ing. Diclofenac Edema, nausea, itching
Ceftriaxone Cough, fever, black stools
Pantoprazole Headache, vomiting,
nausea
 PATIENT COUNSELLING

 Maintain a healthy diet

 Semisolid diet only
 CASE SUMMARY

A17 year old female was admitted to hospital in surgery ward with
complaints of sever abdominal pain, constipation, vomiting
containing indigested food.
X ray report of abdomen shows obstruction in gut and multiple air
fluid level and ultrasound reported small amount of fluid present in
peritoneal cavity.