OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is small bowel obstruction. While this may seem a odd practice, it is useful to see multiple examples of how small bowel obstruction will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 50 year old woman is brought to the emergency department because she has been experiencing abdominal pain, nausea, and vomiting for the past day. She also complains that she has been experiencing an increased stomach size. Her last bowel moment was 20 hours ago. She underwent a painful tooth extraction a few days ago and has been taking codeine for pain control. Her past medical history is notable for an appendectomy as a teenager and a total hysterectomy 6 years ago for uterine fibroids. The patient’s pulse is 115/min, blood pressure is 115/80 mm Hg, and respirations are 16/min. A physical exam is remarkable for a distended and tympanic abdomen that is diffusely tender to palpation. Bowel sounds are high pitched and a rectal examination is unremarkable. An abdominal X-ray is conducted and shows distended loops of small bowel with multiple air-fluid levels. There is no air in the rectum that can be seen on the film. What is the likely diagnosis?
Explanation: high pitched bowel sounds + distended small bowel loops + multiple air/fluid levels on X-ray = small bowel obstruction
Question #2
A 80 year old woman comes to the clinic because she has been experiencing nausea, vomiting, and abdominal pain for the past 2 days. Most recently she noticed that she vomited very soon after eating said food. Her last bowel movement was 3 days ago and was unremarkable. She explains that she usually passes stool every 1 to 2 days. Her past medical history is notable for type 2 diabetes and a past open cholecystectomy for cholecystitis 12 years ago. She currently is on insulin, lisinopril, and aspirin. She does not smoke or drink alcohol. Her heart rate is 98/min, and her blood pressure 115/70 mm. An abdominal exam is remarkable for mild distention and there is tenderness without any rebound or guarding. Auscultation of the abdomen reveals high pitched bowel sounds that are increased in frequency. An abdominal x-ray shows dilated loops of small bowel and there are multiple air-fluid levels present without a clear transition zone of free air. What is a likely diagnosis?
Explanation: high pitched bowel sounds + multiple air fluid levels on X-ray = small bowel obstruction
Question #3
A 55 year old man has had colicky abdominal pain and vomiting for several days. He has also noticed a progressive abdominal distention, and has not had a bowel movement or passed any gas for 4 days. He has high pitched, loud bowel sounds that coincide with colicky pain that can be appreciated on a physical exam. X-rays show multiple distended loops of small bowel and air-fluid levels. 6 years ago he had an exploratory laparotomy for a gunshot wound of the abdomen.
Explanation: high pitched bowel sounds + multiple air fluid levels on X-ray = small bowel obstruction
Question #4
A 50 year old man has had colicky abdominal pain and vomiting for several days. He has also noticed a progressive abdominal distention, and has not had a bowel movement or passed any gas for 4 days. He has high pitched, loud bowel sounds that coincide with colicky pain that can be appreciated on a physical exam. X-rays show multiple distended loops of small bowel and air-fluid levels. A physical exam also reveals a groin mass that the patient explains that he used to be able to “push back” however he has been unable to do so for the past 4 days.
Explanation: high pitched bowel sounds + multiple air fluid levels on X-ray = small bowel obstruction (secondary to hernia)
Question #5
A 30 year old male comes to the hospital with persistent vomiting and abdominal pain for the past day. The pain is crampy and diffuse. It has been getting worse all day. The patient’s last normal bowel movement was 3 days ago. His emesis is green without blood or any appearance of coffee grounds. The patient has lost his appetite due to his nausea, and has not eaten since the onset of symptoms. The patient’s past medical history is notable for an open appendectomy 8 months ago. His temperature is 98.4°F, pulse is 92/min, blood pressure is 120/75 mm Hg when sitting and 90/70 mm Hg while standing. His abdomen is distended, and their are hyperactive bowel sounds. Percussion of the abdomen reveals tympani and the patient is diffusely tender to abdominal palpation. The patient does not have any glaring or rebound tenderness. Lab results are shown below:
- Hemoglobin: 14.0 g/dL
- WBC count; 9,300 cells/µL
- Sodium: 146 mEq/L
- Potassium: 3.2 mEq/L
- Creatinine: 1.0 mg/dL
- Aspartate aminotransferase: 15 U/L
- Alanine aminotransferase: 15 U/L
- Total bilirubin: 0.7 mg/dL
What is the likely diagnosis in this patient?
Explanation: past history of abdominal surgery + vomiting + abdominal distention + constipation = small bowel obstruction
Page Updated:01.22.2017