What is your diagnosis now? Other considerations? Bases?

SMALL BOWEL OBSTRUCTION Abdominal pain. Most small-bowel obstructions cause waves of cramping abdominal pain. The pain occurs around the belly button (periumbilical area). If an obstruction goes on for a while, the pain may decrease because the bowel stops contracting. Continuous severe pain in one area can mean that the blockage has cut off the bowel's blood supply. This is called a bowel strangulation and requires emergency treatment. Vomiting. Small-bowel obstructions usually cause vomiting. The vomit is usually green if the obstruction is in the upper small intestine and brown if it is in the lower small intestine. Elimination problems. Constipation and inability to pass gas are common signs of a bowel obstruction. However, when the bowel is partially blocked, you may have diarrhea and pass some gas. If you have a complete obstruction, you may have a bowel movement if there is stool below the obstruction. Bloating. Blockages may cause bloating in the lower abdomen. You may also hear gurgling sounds coming from your belly. With a complete obstruction, your doctor may hear high-pitched sounds when listening with a stethoscope. The sounds decrease as movement of the bowel slows

SMALL BOWEL OBSTRUCTION In small bowel obstruction the pain tends to be colicky (cramping and intermittent) in nature, with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting occurs before constipation

Depending on the level of obstruction, bowel obstruction can present with abdominal pain, abdominal distension, vomiting, fecal vomiting, and constipation. Obstruction may be due to causes within the bowel lumen, within the wall of the bowel, or external to the bowel (such as compression, entrapment or volvulus).

OTHER CONSIDERATIONS

LARGE BOWEL OBSTRUCTION In the large intestine, obstructions are most often caused by cancer . Other causes are severe constipation from a hard mass of stool and twisting or narrowing of the intestine that may occur because of diverticulitis or inflammatory bowel disease

LARGE BOWEL OBSTRUCTION Symptoms of large-bowel obstruction can include: A bloated abdomen Abdominal pain, which can be either vague and mild, or sharp and severe, depending on the cause of the obstruction Constipation at the time of obstruction, and possibly intermittent bouts of constipation for several months beforehand If a colon tumor is the cause of the problem, a history of rectal bleeding (such as streaks of blood on the stool) Diarrhea resulting from liquid stool leaking around a partial obstruction Blockages caused by cancer may cause symptoms such as blood in the stool, weakness, weight loss, and lack of appetite.

COLON CANCER � About half of all large-bowel obstructions are caused by colorectal cancer. Undiagnosed colon or rectal cancer may cause a gradual narrowing of the large intestine's inner passageway. Usually patients experience intermittent constipation for a while before the bowel finally becomes obstructed.

The symptoms of colorectal cancer depend on the location of tumor in bowel and whether it has spread to elsewhere in the body (metastasis). Symptoms and signs are divided into local, constitutional (affecting the whole body) and metastatic (caused by spread to other organs).

LOCAL tumor that is large enough to fill the entire lumen of the bowel may cause bowel obstruction. This situation is characterized by constipation, abdominal pain, abdominal distension and vomiting as seen in the patient CONSTITUTIONAL If a tumor has caused chronic occult bleeding, iron deficiency anemia may occur; this may be experienced as fatigue, palpitations and noticed as pallor (pale appearance of the skin). Colorectal cancer may also lead to weight loss generally due to a decreased appetite

METASTATIC Colorectal cancer most commonly spreads to the liver. This may go unnoticed, but large deposits in the liver may cause jaundice and abdominal pain (due to stretching of the capsule). If the tumor deposit obstructs the bile duct, the jaundice may be accompanied by other features of biliary obstruction, such as pale stools.