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1. What is intestinal obstruction? What are the two main groups?
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Correct answer:
Intestinal obstruction is a restriction to the normal passage of intestinal contents. It may be divided into two main groups: paralytic and mechanical.
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2. What are the alternative names for paralytic obstruction?
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Correct answer:
Paralytic or adynamic ileus.
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3. How is mechanical obstruction classified?
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Correct answer:
(1) Speed of onset: acute, chronic, acute on chronic.
(2) Site: high or low.
(3) Nature: simple versus strangulating.
(4) Aetiology.
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4. What are the three important points to remember about intestinal obstruction?
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Correct answer:
(1) It is diagnosed by the presence of: colicky abdominal pain, distension, absolute constipation, vomiting.
(2) Examination should always include a search for hernias.
(3) Is it simple or strangulating? Features suggesting strangulation are: change in character of pain from colicky to continuous, peritonism, tachycardia, pyrexia, leucocytosis, raised C-reactive protein, bowel sounds absent or reduced.
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5. What are the four main symptoms of mechanical intestinal obstruction?
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Correct answer:
(1) Colicky abdominal pain.
(2) Distension.
(3) Absolute constipation.
(4) Vomiting.
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6. Which features suggest that a mechanical obstruction has become strangulated?
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Correct answer:
(1) Change in character of pain from colicky to continuous; (2) pyrexia; (3) tachycardia; (4) peritonism; (5) leucocytosis; (6) bowel sounds absent or reduced; (7) raised C-reactive protein.
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7. What is the relevance of the speed of onset of a mechanical intestinal obstruction?
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Correct answer:
The speed of onset determines whether the obstruction is acute, chronic or acute on chronic. In acute obstruction the onset is rapid and the symptoms are severe. In chronic obstruction the symptoms are insidious and slowly progressive (as, for example, in most cases of carcinoma of the large bowel). A chronic obstruction may develop acute symptoms as the obstruction suddenly becomes complete, e.g. when a narrowed lumen becomes totally occluded by inspissated bowel contents. This is termed acute-on-chronic obstruction.
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8. How is the site of a mechanical intestinal obstruction classified?
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Correct answer:
The site of the obstruction is classified into high or low, which is roughly synonymous with small or large bowel obstruction.
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9. What are the different types of mechanical intestinal obstruction?
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Correct answer:
This occurs when the bowel is occluded without damage to its blood supply.
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10. What is a simple obstruction?
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Correct answer:
This reveals the pyloric obstruction with characteristic shouldering of the pyloric antrum due to the impression made on it by the hypertrophied pyloric muscle. However, this investigation is rarely called for.
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11. What is a strangulated obstruction?
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Correct answer:
This is when the blood supply of the involved segment of intestine is cut off (as may occur, for example, in strangulated hernia, volvulus, intussusception or when a loop of intestine is occluded by a band). Gangrene of the strangulated bowel is inevitable if left untreated.
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12. What will happen to a strangulated piece of bowel?
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Correct answer:
It will become gangrenous.
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13. How should the cause of mechanical intestinal obstruction be classified?
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Correct answer:
(1) Causes in the lumen. (2) Causes in the wall. (3) Causes outside the wall.
