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1. Where does the word ileus come from?
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Correct answer:
The word ileus comes from the Greek verb ‘to roll’, from which it became applied to colic and hence obstruction.
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2. What are the two major subdivisions of obstructions?
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Correct answer:
Mechanical and paralytic.
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3. Why is it bad practice to say that a patient has an ‘ileus’ if you mean a ‘paralytic ileus’?
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Correct answer:
An ‘ileus’ comes from the Greek verb ‘to roll’ and refers to the pain of mechanical obstruction.
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4. What are the other names for a paralytic ileus?
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Correct answer:
Adynamic ileus or neurogenic ileus.
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5. What are the four principal features of a paralytic ileus?
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Correct answer:
(1) Vomiting.
(2) Abdominal distension.
(3) Absolute constipation.
(4) Absence of intestinal movements and, hence, absence of colicky pain.
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6. What type of pain is felt by a patient with a paralytic ileus?
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Correct answer:
No pain. There is no colicky pain because there is absence of intestinal movements.
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7. What are the five major causes of paralytic ileus?
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Correct answer:
(1) Drugs. (2) Reflex paralytic ileus. (3) Postoperative. (4) Peritonitis. (5) Metabolic factors.
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8. What is reflex paralytic ileus?
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Correct answer:
This probably results from interference with the autonomic nerve supply of the gut; it may complicate fractures of the spine or pelvis, application of a plaster cast, retroperitoneal haemorrhage and retroperitoneal surgery, intestinal ischaemia, ureteric colic and occasionally parturition. When the colon alone is affected, it has been termed colonic pseudo-obstruction.
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9. What is Ogilvie’s syndrome?
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Correct answer:
This is a state of reflex paralytic ileus in which only the colon is affected. It is another name for colonic pseudo-obstruction.
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10. What are the causes of reflex paralytic ileus?
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Correct answer:
(1) Plaster cast. (2) Ureteric colic. (3) Fractures of the spine or pelvis. (4) Retroperitoneal haemorrhage or surgery. (5) Intestinal ischaemia. (6) Parturition (occasionally).
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11. Why does peritonitis cause paralytic ileus?
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Correct answer:
Perhaps as a result of toxic paralysis of intrinsic nerve plexuses, the bowel in peritonitis becomes atonic. There may be an associated mechanical obstruction produced by kinking of loops of bowel by fibrinous adhesions, so that frequently the paralytic ileus is complicated by mechanical ileus.
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12. Which metabolic factors can cause paralytic ileus?
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Correct answer:
(1) Diabetic coma. (2) Uraemia. (3) Potassium depletion (severe).
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13. Which drugs can cause a paralytic ileus?
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Correct answer:
Anticholinergic drugs; antiparkinsonian drugs.
