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I Human Case Study On Physical Examination Week #3 Case Study: Fecal Impaction
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I Human Case Study On Physical Examination Week #3 Case Study: Fecal Impaction
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lOMoARcPSD| 46020670Case Study: Fecal Impaction
I Human Case Study On Physical Examination
Week #3
Advanced Health Assessment and Diagnostic Reasoning.
Topic: Differential Diagnoses and Diagnostic Testing
Oluwasogo Israel Oriola
Walden University
September 16, 2024
Case Study
Mr. RG is a retired 75 y/o male coming to the office with a 2-week inability to move his bowels.
He is a widower who has a history of hypertension. On his vital signs, his BP is 168/95. During
the interview, RG told you about a hard lump in his left lower quadrant. Identify the patient’s
chief complaint. Identify what physical exams and diagnostic tests would be most appropriate to
gather more information about the patient's condition. Be specific and explain your reasoning.
Explain how the results would be used to make a diagnosis. Identify three to five (3–5) possible
conditions that may be considered in a differential diagnosis for the patient. Explain your
thinking.
Analysis
A patient presenting with an inability to have a bowel movement for a duration of two weeks,
along with a discernible hard mass in the left lower quadrant of the abdomen, is likely
experiencing fecal impaction. This medical condition is characterized by a significant, hardened
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, lOMoARcPSD| 46020670
Case Study: Fecal Impaction
stool mass that becomes trapped in the rectum, often because of severe constipation, and is
commonly linked to the detection of a palpable mass in the abdominal region.
Fecal impaction (FI) is a notable factor contributing to obstructions in the lower
gastrointestinal tract, second only to strictures resulting from diverticulitis and colon cancer. This
condition often develops because of chronic or severe constipation, with a notably higher
incidence in the elderly population. Despite the presence of a thriving laxative industry and a
growing societal awareness regarding bowel health, fecal impaction remains a prevalent concern,
particularly among both pediatric and geriatric groups.
The risk of developing fecal impaction increases with age, significantly diminishing the
quality of life for older adults. A study by Read et al. (1985) indicated that 42% of patients in a
geriatric ward were impacted by this condition. Furthermore, fecal impaction is commonly seen
in individuals with neuropsychiatric conditions, such as Alzheimer's disease, Parkinson's disease,
dementia, and those who have experienced severe strokes, as well as in patients with spinal cord
injuries.
The underlying causes of fecal incontinence (FI) are closely aligned with those that lead
to constipation. FI is frequently viewed as a direct result of chronic constipation that has not been
adequately addressed. Key risk factors include decreased colonic motility, low dietary fiber
intake, and insufficient hydration; thus, the populations most vulnerable to this condition are the
elderly and those with neuropsychiatric conditions.
An increase in dietary fiber to 30 grams per day, coupled with adequate fluid intake, can
significantly mitigate the risks of constipation and fecal impaction resulting from poorly
processed fiber. Furthermore, diminished mobility, often seen in older adults or individuals with
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