MEDizzy - You are evaluating a 63-year-old man who complains of

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Acute Complaints

You are evaluating a 63-year-old man who complains of abdominal pain, distension, nausea, and vomiting. It began rather suddenly this morning, though he has had mild diffuse pain for several days. His past history is significant for a recent partial sigmoid resection for diverticulosis and an appendectomy at 23 years of age. On examination, he is afebrile, his mucous membranes are dry, but he has no orthostatic symptoms. His abdomen is distended and diffusely tender, and his bowel sounds are high-pitched. Which of the following is the most likely cause of his nausea and vomiting?

ExplanationA careful history and physical examination can often distinguish between potential causes for nausea and vomiting. In this case, mild pain, followed by the acute onset of distension, nausea, and vomiting is consistent with ileus or obstruction. High pitched or hyperactive bowel sounds lead one to think of obstruction; with an ileus, bowel sounds are absent. Gastroenteritis begins acutely, but is usually not preceded by mild abdominal pain. Diverticulosis and diverticulitis would cause pain, but would be less likely to present with nausea, vomiting, and distension.