What's the next management? - arya

[ArchivalUser]

A 50 yr old man has had constipation and hasn't passed flatus, for 2 days. For the last 3 days he has been having intermittent, but worsening, RLQ pain. He has vomited several times today and feels nauseated. His abdomen is distended and tender in the RLQ, without rebound' no masses or hernias noted. Bowel sounds are absent. REctal exam shows enlarged prostate.Upright abdominal X-ray shows gas distributed throughout the small and large bowel, and some fluid levels. After NG tube placement and hydration, his vital signs and lab tests: PR 57, BP 140/80, RR 12 T 36.5C

RBC 4.5 million
WBC 7,400
Na 140
K 3.5
Cl 100
BUN 15
Creatinine 1.0
urine pH 5.5
Urine sediment: 2
WBC and RBC 15/high power field
Urine needle shaped crystals are present.

What the next most appropriate step in the management?

A. Barium enema
B. sigmoidoscopy
C. colonoscopy
D. CT of abdomen
E. enteroclysis

[ArchivalUser]

is it barium enema?

[ArchivalUser]

CT scan

[ArchivalUser]

is it D?
post renal urinary obstruction on the right (possibly due to intraurethral uric acid stone or BPH) causing UTI, sepsis and paralytic ileus?

don't say i didn't try. ))

[ArchivalUser]

D. the pt have urinary obstruction cause by stone

[ArchivalUser]

ct scan, pt has paralytic ileus due to renal stones.

[ArchivalUser]

D is right and lisy gave the correct explanation.