Chapter 83: Bowel Obstruction

Question 1

Accounts for most bowel obstructions

Answer 1

Small bowel obstruction

Question 2

The most common cause of small bowel obstruction

Answer 2

Adhesions after abdominal surgery

Question 3

The second most common cause of small bowel obstruction

Answer 3

Incarceration of a hernia

Question 4

Key features of Ileus compared to bowel obstruction

Answer 4

Pain: mild to moderate
Location: diffuse
PE: mild distention, +/- tenderness, decreased bowel sounds
Lab: dehydration
Imaging: may be normal
Tx: observation and hydration

Question 5

Bariatric surgery may be complicated by ____ after Roux-en-Y gastric bypass

Answer 5

Bariatric surgery may be complicated by internal hernias after Roux-en-Y gastric bypass

Question 6

Type of polyp that in common in Peutz-Jeghers syndrome

Answer 6

Hamartomatous polyp

Question 7

In gallstone ileus, the obstruction happen at?

Answer 7

Ileocecal valve

Question 8

The leading point of intussusception and present as small bowel obstruction

Answer 8

Lymphomas

Question 9

Most commonly composed of vegetable matter or pulp from persimmons.

Answer 9

Bezoars

Question 10

Which patient are most susceptible to intraluminal obstruction by bezoars

Answer 10

Undergone GI pyloroplasty or pyloric resection

Question 11

Blunt abdominal trauma may cause

Answer 11

Blunt abdominal trauma may cause a duodenal hematoma

Question 12

The most common cause of large bowel obstruction

Answer 12

Neoplasm

Question 13

The next most frequent cause of large bowel obstruction after cancer and diverticulitis is

Answer 13

Sigmoid volvulus

Question 14

The pain of large bowel obstruction is usually ____

Answer 14

The pain of large bowel obstruction is usually hypogastric

Question 15

In small bowel obstruction, it is the most reliable sign

Answer 15

Distention

Question 16

Reliable sign of sigmoid volvulus

Answer 16

Emptiness of the left iliac fossa

Question 17

True or False
The absence of stool or air in the rectal vault supports a diagnosis of obstruction and may aid in the diagnosis of bowel obstruction, but its presence does not eliminate a more proximal obstruction

Answer 17

True
The absence of stool or air in the rectal vault supports a diagnosis of obstruction and may aid in the diagnosis of bowel obstruction, but its presence does not eliminate a more proximal obstruction

Question 18

True or False
A leukocytosis of >40,000/mm3 or left shift should make one suspect bowel gangrene, intra-abdominal abscess, or peritonitis

Answer 18

False
A leukocytosis of >20,000/mm3 or left shift should make one suspect bowel gangrene, intra-abdominal abscess, or peritonitis

Question 19

True or False
Leukocytosis of (>20,000/mm3) suggests mesenteric vascular occlusion

Answer 19

False
Extreme leukocytosis (>40,000/mm3) suggests mesenteric vascular occlusion

Question 20

This test may predict bowel ischemia or failure of conservative management

Answer 20

Procalcitonin

Question 21

True or False

CT scan with oral and IV contrast is the imaging method of choice in the ED with bowel obstruction

Answer 21

True

CT scan with oral and IV contrast is the imaging method of choice in the ED

Question 22

True or False

For colonic obstruction due to malignancy, tumor resection is the gold standard treatment

Answer 22

True

For colonic obstruction due to malignancy, tumor resection is the gold standard treatment