The cardinal sign of intestinal obstruction is?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Explanation

Vomiting and abdominal distension are two of the four cardinal signs of intestinal obstruction, along with abdominal pain and absolute constipation (obstipation).
The prominence of these signs helps in identifying the location of the obstruction.
In high (proximal) obstructions, vomiting is an early and significant feature.
In low (distal) obstructions, abdominal distension is more marked and develops earlier than vomiting.

Option A: Diarrhoea is contrary to the classic presentation of complete intestinal obstruction, which is characterized by the inability to pass stool or gas (obstipation).
Option B: This sign, often described as 'currant jelly stool,' is a hallmark feature of intussusception, a specific type of obstruction common in children.
Option C: While some tenderness can occur, significant or localized tenderness is not a primary sign of a simple obstruction. It suggests a more serious complication.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Cardinal signs of intestinal obstruction as background academic context rather than a clinical decision trigger.
Nurses must be vigilant in assessing for the cardinal signs of intestinal obstruction for early detection and intervention.
Key nursing interventions include monitoring fluid and electrolyte balance (especially for hypokalemia due to vomiting), assessing bowel sounds (which may be hyperactive initially and then absent), and managing nasogastric tube decompression.
Prompt recognition is crucial as delayed treatment can lead to bowel ischemia, perforation, sepsis, and shock.

How to Approach the Question

First, identify the keywords in the question: 'cardinal sign' and 'intestinal obstruction'. 'Cardinal sign' refers to the most important, primary sign of a disease.
Recall the four classic cardinal signs of intestinal obstruction: abdominal pain, vomiting, abdominal distension, and absolute constipation (obstipation).
Evaluate each option to see which one aligns with these cardinal signs.
Option D, 'Vomiting and distension,' includes two of the four cardinal signs.
Analyze the incorrect options: 'Diarrhoea' is the opposite of constipation. 'Jelly-like stool' is specific to intussusception. 'Localized tenderness' suggests a complication rather than a primary sign.
Conclude that 'Vomiting and distension' is the best description of a cardinal sign among the given choices.

Concept Tested & Keywords

QyYuQcba769Lj3Xp4a6LaH

E6 Medicine Harrison 22e Part 1 p. 628-630

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 62-64, 82-84

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