What is a common clinical feature of Intestinal obstruction?

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

Bilious vomiting is a cardinal sign of intestinal obstruction, especially when the blockage is in the small bowel, distal to where bile enters the digestive tract.
The obstruction prevents the forward flow of intestinal contents, causing a backup of fluid, food, and bile, which is then expelled as greenish-yellow vomit.
Its appearance is often early and frequent in proximal small bowel obstructions.

Option B: Intestinal obstruction typically causes constipation or obstipation (inability to pass stool or gas) due to the physical blockage.
Option C: Fever is not a primary or common sign of a simple obstruction. It is a late finding and a red flag for a serious complication.
Option D: This option is incorrect because two of the listed features, diarrhea and fever, are not common clinical features of an uncomplicated intestinal obstruction.

Visual 1: Diagram - An illustration of the gastrointestinal tract showing different potential sites of intestinal obstruction (e.g., small bowel vs. large bowel) and the location of the ampulla of Vater to explain why vomiting becomes bilious.
Visual 2: Infographic - A chart summarizing the four cardinal signs of bowel obstruction: colicky abdominal pain, vomiting, abdominal distension, and absolute constipation.

Clinical Relevance

Nursing practice connection: Knowing Clinical manifestations of intestinal obstruction helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
For a nurse, recognizing bilious vomiting is a critical assessment finding that points towards a potential bowel obstruction, requiring prompt notification of the physician and initiation of emergency care.
Failure to act quickly can lead to bowel ischemia, necrosis, perforation, and sepsis, which are life-threatening emergencies.
What if the patient's vomiting was non-bilious and contained recently eaten food? This would suggest the obstruction is higher up, such as at the gastric outlet or in the pylorus, changing the immediate diagnostic focus.

How to Approach the Question

First, identify the core concept of the question, which is the 'common clinical feature' of 'intestinal obstruction'.
Recall the four cardinal signs of intestinal obstruction: colicky abdominal pain, vomiting, abdominal distension, and absolute constipation (obstipation).
Evaluate each option against these cardinal signs.
Option A, 'Bilious vomiting', is a specific type of vomiting that is a hallmark of obstruction in the small intestine.
Option B, 'Diarrhea', is the opposite of the expected sign of constipation.
Option C, 'Fever', is a sign of complication, not a common initial feature.

Concept Tested & Keywords

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Practise the full NORCET 2 - 2021 (shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.