MCQ - Intestinal obstruction

Inteststinal obstruction

MCQ

 

1.Complete mechanical small bowel obstruction can cause dehydration by:

 

A  Inducing vomiting.

B. Decreasing intestinal absorption of water.

C. Causing secretion of water into the intestinal lumen.

D. all of the above.

 

2.Commonest cause of intestinal obstruction:

 

A.  Tumors

B.   Inflamatory

C.   Adhesions

D.   Intraluminal

 

3.All are true except:

 

A. Jejunum is characterized by valvulae conniventes

B.  Ileum is featureless.

C.  Haustral folds completely pass across the width & regularly placed.

D. Two fluid level in small bowel considered normal.

 

4.All are the signs of strangulation except:

 

A.     severe colicky abdominal pain

B.     fever

C.     tenderness with rigidity

D.     shock

 

5.What is the following radiological element which reveal a gall stone ileus?

 

A. Air under diaphragm.

B. Air-fluid level of small gut.

C. Pneumobilia.

D. Enlargement of parieto-colic groove.

 

6.Most reliable sign of non-viability of bowel

   

A. absent peristalsis

B. loss of normal shine

C.  loss of pulsation in mesentry

D. green or black color of bowel

 

7.Most common variant of intussusception is

 

A. Ileoileal

B. Ileocolic

C. ileo-ileo-colic

D. colocolic

8.“Constipation is present in intestinal obstruction”, it does not apply in all except

 

 A. Richter’s Hernia

 B. Intussusception

 C. Gallstone obturation.

 D. Mesentric vascular occlusion

 

 

9.Indication for urgent surgery are all except :

 

   A. Failure of conservative management

   B.  Adhesions & bands

   C.  Tender, irreducible hernia

   D.  Strangulation

 

10. Which of the following best describes the initial stages of strangulating obstruction of the small bowel?

 

A. Arterial occlusion

B. Blockage without vascular compromise

C. Blockage with vascular compromise

D. Ischemia of the bowel wall

 

 11. In intestinal obstruction:

(a) Less than 10% of all obstructions are due to adhesions.
(b) The majority of adhesions in the adult population affect the ascending colon.
(c) The mechanism of obstruction has little importance in the final out-come.
(d) Simple obstruction is associated with preservation of mesenteric blood flow.

 

12.In intestinal obstruction:

(a) Less than 10% of all obstructions are due to adhesions.
(b) The majority of adhesions in the adult population affect the ascending colon.
(c) The mechanism of obstruction has little importance in the final out-come.
(d) Simple obstruction is associated with preservation of mesenteric
blood flow.

  

Answers

1d  2c  3c  4a  6b  6d  7b  8d  9b  10c  11d    

 

 

Clinical case

A 45-year-old man presented to the emergency department with colicky abdominal pain, vomiting, and a painful groin lump. 

On examination he had a pulse of 110 beats/min and temperature of 37.8°C. 

There was marked abdominal distension, high pitched bowel sounds, and an erythematous, tender mass in the left groin above and medial to the pubic tubercle.

A plain abdominal radiograph was taken in the emergency department (Fig 1).

 

Fig 1 Plain abdominal radiograph showing evidence of small bowel obstruction

 1. What does the Xray show?

AXR shows a loop of small bowel leading towards the position of an inguinal hernia.

  

2. What is the next step in management?

A. Apply local pressure to the swelling to reduce it

B. Discharge with analgesia

C. Elective surgery

D. Nil by mouth, nasogastric tube, and intravenous drip

E. Reassurance and book an outpatient department appointment.

2. D

The history is consistent with small bowel obstruction secondary to an irreducible inguinal hernia—above and medial to the pubic tubercle.

The concern here is that the bowel is ischaemic and is at risk of perforation, which would put the patient at risk.

Initial management should aim to correct dehydration and electrolyte imbalance.