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A 43-year-old woman with a prior history of open cholecystectomy

43 years old | Female

Vignette:

A 43-year-old woman with a prior history of open cholecystectomy presents with gradual onset of nausea, vomiting, absolute constipation, and abdominal distention. Physical exam does not demonstrate peritonitis. Abdominal x-rays demonstrate scattered air-fluid levels.

Summary:

prior history of open cholecystectomy | history of abdominal surgery | gradual onset | nausea | vomiting | constipation | abdominal distention | radiograph scattered air-fluid levels

Dx:

Intestinal Obstruction Small bowel obstruction

Ref:

https://online.epocrates.com/diseases/99322/Small-bowel-obstruction/Common-Vignette

Rank

Disease

Weight

1 Gastroparesis 394.0
2 Intestinal Obstruction 375.0
3 Sigmoid volvulus 362.0
4 Ruptured ectopic pregnancy 353.0
5 Acute Pancreatitis 335.0
6 Acute Appendicitis 302.0
7 Intussusception 301.0
8 Hereditary Angioedema 298.0
9 Acute intermittent porphyria 297.0
10 Migraine headache in adults 297.0
11 Acute perforated appendicitis 275.0
12 Mesenteric ischemia 274.0
13 Intestinal Pseudo Obstruction 268.0
14 Ileus 267.0
15 Gastric Outlet Obstruction 267.0
16 Gastritis 264.0
17 Acute peptic ulcer 246.0
18 Ovarian Cancer 237.0
19 Kidney stones 228.0
20 Diverticulitis 227.0
21 Alcoholic Liver Disease 222.0
22 Gallstone pancreatitis 219.0
23 Giardiasis 218.0
24 mucosal Eosinophilic gastroenteritis 213.0
25 Pyogenic Liver Abscess 211.0
26 Acute Cholecystitis 211.0
27 Emphysematous cholecystitis 211.0
28 Ulcerative Colitis 207.0
29 Acute fatty liver of pregnancy 207.0
30 Irritable Bowel Syndrome 198.0
31 Addison Disease 197.0
32 Esophagitis 195.0
33 Ovarian and fallopian tube torsion 194.0
34 Anaphylaxis 192.0
35 Klebsiella pneumoniae liver abscess 190.0
36 Ovarian Torsion 189.0
37 Ovarian Hyperstimulation Syndrome 184.0
38 Alcoholic Liver Cirrhosis 183.0
39 Dyspepsia 181.0
40 Gallbladder cancer 179.0
41 Food poisoning 177.0
42 Muscle Layer Eosinophilic gastroenteritis 177.0
43 Angle Closure Glaucoma 177.0
44 Lactose intolerance 176.0
45 Rocky Mountain spotted fever 176.0
46 Crohn Disease 173.0
47 Meckel diverticulum 172.0
48 Hiatus hernia 170.0
49 Gastric Volvulus 169.0
50 Ectopic Pregnancy 166.0
51 biliary colic 166.0
52 Choledochal Cyst 165.0
53 Hypercalcemia 165.0
54 Amebic Liver Abscess 162.0
55 Diabetic Ketoacidosis 162.0
56 Gallbladder Dyskinesia 160.0
57 Type 2 Diabetes mellitus 160.0
58 Bacterial pharyngitis 159.0
59 Foreign body ingestion 159.0
60 Primary biliary cirrhosis 158.0
61 Spontaneous bacterial peritonitis 158.0
62 Primary sclerosing cholangitis 156.0
63 Migraine 155.0
64 biliary SOD 154.0
65 Liver disease 153.0
66 Systemic sclerosis 150.0
67 Acute disseminated encephalomyelitis 149.0
68 Non-cholera Vibrio infections 147.0
69 Ascites 146.0
70 Acute pericarditis 146.0
71 Diabetic Neuropathy 146.0
72 Thrombotic thrombocytopenic purpura 146.0
73 Biliary cirrhosis 145.0
74 Peptic Ulcer 145.0
75 Alcoholic Fatty Liver 144.0
76 Brucellosis 144.0
77 pancreatic cancer 143.0
78 Anthrax 143.0
79 Henoch-Schonlein purpura 143.0
80 Alcoholic hepatitis 142.0
81 Inguinal hernia 140.0
82 Splenic Infarction 139.0
83 Acute viral meningitis 138.0
84 Hyperparathyroidism 137.0
85 Motion Sickness 136.0
86 Familial Mediterranean fever 135.0
87 Duodenal Ulcer 134.0
88 Gastric Ulcer 134.0
89 Premenstrual syndrome 134.0
90 Acetaminophen overdose 132.0
91 Intra-abdominal abscess 130.0
92 Acute Hepatitis 130.0
93 Liver Cirrhosis 130.0
94 Sphincter of Oddi Dysfunction 130.0
95 pancreatic SOD 130.0
96 Aseptic meningitis 130.0
97 Abdominal compartment syndrome 130.0
98 Acute bacterial meningitis in adults 129.0
99 Toxic Megacolon 129.0
100 Gallstones 128.0
101 Choledocholithiasis 128.0
102 Hemolytic uremic syndrome 127.0
103 Type 1 Diabetes mellitus 126.0
104 Typhoid infection 126.0
105 Aortic Dissection 125.0
106 Diabetes Mellitus 124.0
107 Campylobacter infection 123.0
108 Pyelonephritis 122.0
109 Acute Liver Failure 120.0
110 Viral Gastroenteritis 120.0
111 Analgesic nephropathy 119.0
112 Autosomal Dominant Polycystic Kidney Disease 119.0
113 Labyrinthitis 118.0
114 Tuberculous Peritonitis 116.0
115 Liver Abscess 115.0
116 Peutz-Jeghers Syndrome 115.0
117 Milk-alkali syndrome 115.0
118 Acute Milk-alkali syndrome 115.0
119 Chronic Milk-alkali syndrome 115.0
120 Osteoporosis 113.0
121 Hemorrhagic stroke 112.0
122 Gastric cancer 111.0
123 Adrenal crisis 111.0
124 Amphetamine use disorder 108.0
125 Acute Clonorchiasis 108.0
126 Clostridium difficile infection 107.0
127 Non-ST-elevation myocardial infarction 107.0
128 Acute bacterial meningitis in children 107.0
129 Acute pyelonephritis in adults 107.0
130 Autoimmune hepatitis 106.0
131 Intraperitoneal bleeding 106.0
132 Hypothyroidism 106.0
133 Chronic pyelonephritis 106.0
134 Acute otitis media 105.0
135 Ankylosing spondylitis 105.0
136 Annular pancreas 104.0
137 Sarcoidosis 104.0
138 Celiac Disease 103.0
139 Salmonella infection 103.0
140 Ischemic stroke 103.0
141 Stable ischemic heart disease 102.0
142 Leiomyomas 102.0
143 Polyarteritis nodosa 102.0
144 Papilledema 102.0
145 Chronic heart failure 100.0
146 Amyloidosis 100.0
147 End Stage Renal Disease 100.0
148 Subdural hematoma 100.0
149 Umbilical hernia 97.0
150 Pancreatic Pseudocyst 96.0
151 subserosal eosinophilic gastroenteritis 95.0
152 Anal Fissure 95.0
153 Hypertriglyceridemia 94.0
154 ST-elevation myocardial infarction 94.0
155 Non-small cell lung cancer 94.0
156 Graves Disease 92.0
157 Painless thyroiditis 92.0
158 Chronic bacterial prostatitis 91.0
159 Travelers diarrhea 90.0
160 Common cutaneous drug reactions 89.0
161 Diabetic Amyotrophy 88.0
162 Systemic lupus erythematosus 88.0
163 Colorectal cancer 87.0
164 Secondary Peritonitis 87.0
165 Urinary Tract Obstruction 85.0
166 Cholangiocarcinoma 85.0
167 Malaria 85.0
168 Bell palsy 84.0
169 Acalculous Cholecystitis 84.0
170 chronic acalculous cholecystitis 84.0
171 Meniere disease 84.0
172 Autosomal Recessive Polycystic Kidney Disease 82.0
173 Peritoneal dialysis associated peritonitis 82.0
174 Listerial gastroenteritis 82.0
175 Adrenal Suppression 82.0
176 Fungal meningitis 82.0
177 Heparin-induced thrombocytopenia 81.0
178 Infectious mononucleosis 81.0
179 Chronic pelvic pain in women 81.0
180 Eosinophilic gastroenteritis 80.0
181 Wilson disease 80.0
182 Hepatic Encephalopathy 79.0
183 Cellulitis 79.0
184 Shigellosis 79.0
185 Multiple endocrine neoplasia 2A 79.0
186 Diabetic Kidney Disease 78.0
187 Hyperthyroidism 77.0
188 Intestinal malrotation 77.0
189 Foodborne E coli infection 76.0
190 Acute pelvic inflammatory disease 75.0
191 Cataract 75.0
192 Ruptured ovarian cyst 75.0
193 Chronic Pancreatitis 75.0
194 Hepatorenal Syndrome 75.0
195 Alopecia areata 75.0
196 Cholera 75.0
197 Rumination Syndrome 75.0
198 Acute Lymphoblastic leukemia in children 75.0
199 Epiploic appendagitis 71.0
200 Pneumonia 70.0
201 Primary Myelofibrosis 70.0
202 Short bowel syndrome 70.0
203 Inflammatory Bowel Diseases 70.0
204 Mallory-Weiss syndrome 70.0
205 Central retinal artery occlusion 68.0
206 Pheochromocytoma 68.0
207 Acromegaly 68.0
208 COPD Exacerbation 68.0
209 Unstable angina 68.0
210 Kawasaki disease 67.0
211 Zollinger-Ellison Syndrome 66.0
212 Torsion of appendix of testis 65.0
213 Hereditary hemochromatosis 65.0
214 Hepatocellular carcinoma 64.0
215 Ruptured Tuboovarian abscess 63.0
216 Gastroesophageal reflux disease 62.0
217 Chronic Hepatitis 62.0
218 Chronic Kidney Diseases 62.0
219 Malt lymphoma 62.0
220 Acute Cholangitis 60.0
221 Sunburn 60.0
222 Budd Chiari Syndrome 59.0
223 Panic disorder in adults 59.0
224 Familial adenomatous polyposis syndrome 58.0
225 Cushing syndrome 56.0
226 Bacterial gastroenteritis 56.0
227 Insect bites and stings 54.0
228 Chronic Renal vein thrombosis 54.0
229 Lung Cancer 54.0
230 Endometrial cancer 54.0
231 anterior ischemic optic neuropathy 53.0
232 Musculoskeletal sprains and strains 53.0
233 Transient ischemic attack 53.0
234 Gout 52.0
235 Cystic Fibrosis 51.0
236 Varicocele 50.0
237 Croup 50.0
238 Breast Cancer 50.0
239 Acute bacterial meningitis in neonates 50.0
240 Chronic meningitis 50.0
241 Goiter 50.0
242 Diffuse nontoxic goiter 50.0
243 Toxic multinodular goiter 50.0
244 Obstructive cervical goiters 50.0
245 Cervical goiter 50.0
246 Xanthelasma 50.0
247 Autoimmune Pancreatitis 49.0
248 Osteomyelitis 49.0
249 Stable angina 49.0
250 Charcot-Marie-Tooth Disease 48.0
251 Cryptococcosis 48.0
252 Influenza 47.0
253 Herpes zoster 46.0
254 Psoas Abscess 46.0
255 Anaplastic thyroid cancer 45.0
256 Central hypothyroidism 45.0
257 Portal hypertension 43.0
258 Acute peritonitis 43.0
259 Chronic Mitral regurgitation 43.0
260 Chlamydia pneumoniae infection 43.0
261 Periorbital and orbital cellulitis 42.0
262 Multiple Sclerosis 42.0
263 Carpal Tunnel Syndrome 41.0
264 Empyema 41.0
265 Hypoparathyroidism 41.0
266 Hyperprolactinemia 41.0
267 Stroke 41.0
268 Rheumatoid Arthritis 40.0
269 Acute heart failure 40.0
270 Sialadenitis 39.0
271 Secondary hyperparathyroidism 38.0
272 Aortic coarctation 38.0
273 Multiple Myeloma 37.0
274 Multiple endocrine neoplasia 2B 37.0
275 Psychogenic polydipsia 37.0
276 Gilbert syndrome 37.0
277 Mitral Stenosis 36.0
278 COVID19 36.0
279 Hypogammaglobulinemia 36.0
280 Parkinson disease 36.0
281 Renal Cell Carcinoma 35.0
282 Chronic Cholecystitis 35.0
283 Chronic liver disease 34.0
284 Prinzmetal angina 34.0
285 Intrahepatic cholestasis of pregnancy 34.0
286 Acute Lymphocytic Leukemia in Adults 34.0
287 Toxic thyroid adenoma 34.0
288 Stevens-Johnson syndrome 34.0
289 Exocrine pancreatic insufficiency 34.0
290 Guillain-Barre syndrome 32.0
291 Non-alcoholic Fatty Liver Disease 31.0
292 Chronic Lymphocytic Leukemia 31.0
293 Acute bacterial rhinosinusitis 30.0
294 Atopic dermatitis 30.0
295 posteriorischemic optic neuropathy 30.0
296 Acute Myeloid Leukemia in children 30.0
297 Premature labor 30.0
298 Obstructive Sleep Apnea 29.0
299 Splenic abscess 29.0
300 Allergic rhinitis 29.0
301 Aortic stenosis 29.0
302 Granulomatosis with polyangiitis 29.0
303 Common cold(adults) 28.0
304 Testicular cancer 28.0
305 Chronic Clonorchiasis 26.0
306 Fibromyalgia 26.0
307 Prolactinoma 25.0
308 Abnormal uterine bleeding 25.0
309 Acute cervical spine trauma 25.0
310 Achalasia 24.0
311 Anemia of chronic disease 24.0
312 Acute respiratory failure 24.0
313 Glomerulonephritis 24.0
314 Acute Myeloid Leukemia in adults 24.0
315 Intestinal Entamoeba histolytica amebiasis 24.0
316 Medullary thyroid cancer 24.0
317 Pelvic inflammatory disease 23.0
318 Paraneoplastic Syndromes 23.0
319 Drowning 23.0
320 Gastroenteritis 23.0
321 Endometriosis 23.0
322 Animal bites 22.0
323 Renal and perinephric abscess 22.0
324 Asthma 22.0
325 Discogenic low back pain 22.0
326 Chronic Myeloid Leukemia 21.0
327 Common cold(children) 20.0
328 Pancreatitis 20.0
329 Acne fulminans 20.0
330 Priapism 20.0
331 Tinnitus 20.0
332 Oropharyngeal cancer 20.0
333 Atypical pneumonia 20.0
334 Tuboovarian abscess 20.0
335 Optic neuritis 20.0
336 Neuropapillitis 20.0
337 Uveitis 18.0
338 Anterior uveitis 18.0
339 Intermediate uveitis 18.0
340 Posterior uveitis 18.0
341 Pan uveitis 18.0
342 Bed bugs 17.0
343 Pulmonary Embolism 16.0
344 Acute atrial fibrillation 16.0
345 Gastrointestinal Hemorrhage 16.0
346 Lower gastrointestinal hemorrhage 16.0
347 Upper gastrointestinal hemorrhage 16.0
348 Simple kidney cyst 15.0
349 Limited cutaneous systemic sclerosis 15.0
350 Churg-Strauss Syndrome 15.0
351 Bullous pemphigoid 15.0
352 Preeclampsia 14.0
353 Eclampsia 14.0
354 Middle East respiratory syndrome 14.0
355 Graves ophthalmopathy 14.0
356 Disseminated intravascular coagulation 14.0
357 Alzheimer disease 13.0
358 Chronic atrial fibrillation 12.0
359 Extraintestinal Entamoeba histolytica amebiasis 12.0
360 Adrenocortical carcinoma 11.0
361 Endometritis 11.0
362 Mirizzi Syndrome 10.0
363 Pressure ulcer 10.0
364 Von willebrand disease 10.0
365 Dacryocystitis 9.0
366 Scleritis 8.0
367 Anterior scleritis 8.0
368 Posterior scleritis 8.0
369 Clonorchiasis 8.0
370 Cryptorchidism 8.0
371 Pseudohypoparathyroidism 7.0
372 Acute Bronchitis 7.0
373 Hyperaldosteronism 6.0
374 Immune thrombocytopenia 6.0
375 Angiodysplasia of the colon 6.0
376 Primary ciliary dyskinesia 5.0
377 Kartagener syndrome 5.0
378 Biliary cyst 5.0
379 Thyroid lymphoma 4.0
380 Essential Tremor 0.0
381 Trachoma 0.0
382 Myasthenia Gravis 0.0
383 Neonatal Myasthenia Gravis 0.0
384 Congenital Myasthenic Syndromes 0.0
385 Conjunctivitis 0.0
386 Epidemic keratoconjunctivitis 0.0
387 Bacterial conjunctivitis 0.0
388 Viral conjunctivitis 0.0
389 Allergic conjunctivitis 0.0
390 Ligneous conjunctivitis 0.0
391 Vernal keratoconjunctivitis 0.0
392 Atopic keratoconjunctivitis 0.0
393 Noninfectious nonallergic conjunctivitis 0.0
394 Abetalipoproteinemia 0.0
395 Acute epididymitis 0.0
396 Hyperosmolar Hyperglycemic state 0.0
397 Acute Cystitis(Men) 0.0
398 Recurrent aphthous stomatitis 0.0
399 Zenker diverticulum 0.0
400 Transverse myelitis 0.0