ROSH Gastrointestinal Practice Exam

What symptom might indicate small bowel obstruction in a patient with a history of prior abdominal surgeries?

1. Diarrhea

2. Vomiting

3. Fever

4. Weight gain

The correct answer is: Vomiting

Vomiting is a key symptom that can indicate small bowel obstruction, particularly in patients with a history of prior abdominal surgeries. Previous surgeries can lead to the formation of adhesions, which are bands of scar tissue that can restrict the movement of the intestines. When an obstruction occurs, the normal passage of contents through the small intestine is impeded, leading to a build-up of material proximal to the obstruction. This build-up causes increased pressure in the bowel lumen, which can trigger nausea and result in vomiting. In the context of small bowel obstruction, vomiting often has specific characteristics, such as being bilious, which means it may contain bile, indicating that the obstruction is distal to the duodenum. Patients may also experience abdominal pain and distension, further supporting the diagnosis of an obstruction. Other symptoms like diarrhea, fever, and weight gain are less indicative of small bowel obstruction. Diarrhea could suggest a different gastrointestinal issue, fever may indicate an infection or inflammation unrelated to obstruction, and weight gain is typically not associated with acute abdominal problems like obstruction. Thus, vomiting stands out as the most relevant symptom to indicate small bowel obstruction in this scenario.