The Clinical Problem Solvers Episode 381 – RLR – Distention – Why?
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Mar 3, 2025 The hosts share their reflections on California's wildfires, weaving humor into serious discussions. They analyze a complex case of a 60-year-old man struggling with abdominal issues, emphasizing diagnostic challenges. The conversation transitions to bowel obstructions, dissecting CT scans and surgical needs. They delve into the intricacies of managing acute situations, focusing on hernias and the importance of clinical reasoning. The exploration of abdominal distention highlights the criticality of recognizing symptoms for effective patient care.
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Rapid Assessment in Bowel Obstruction
- In suspected bowel obstruction, prioritize EKG, bladder scan, and labs.
- Obtain a point-of-care creatinine and proceed to a CT scan.
Differentiating Umbilical Hernias
- Differentiate umbilical hernias caused by bowel obstruction versus pressure.
- Reducible, soft hernias suggest pressure, while hard, immobile ones indicate obstruction.
Bedside Hernia Reduction Success
- A surgeon successfully reduced an incarcerated umbilical hernia at the bedside.
- The patient's bowel obstruction resolved overnight, highlighting a rare curable instance.