This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'A Pseudo-obstruction of 35-year-old comes to the emergency department with symptoms of pain in abdomen and bilious vomiting but no distension of bowel. Abdominal x-ray showed no air fluid level. Diagnosis is \nSelect and explain. \nA. CA rectum, B. Duodenal obstruction, C. Adynamic ileus, D. Pseudoobstruction', 'role': 'user'}, {'content': "Answer: B \nExplanation: Let's see each option one by one\n\nAdynamic ileus or Paralytic ileus\n\nis seen commonly after abdominal operations, or post inflammatory conditions of abdomen eg Appendicitis, peritonitis, pancreatitis. Metabolic abnormalities are also a cause.\nAbdominal distention, usually without the colicky abdominal pain, is the typical & most notable finding.\nVomiting may occur but may also be absent.\nAbsent or hypoactive bowel sounds.\nMultiple air-fluid levels on x-ray.\nPoints b & e help in ruling out dynamic ileus.\n\nPseudo-obstruction\n\nThis condition describes an obstruction, usually of the colon in the absence of any mechanical cause\nThis may occur in acute or chronic form (Acute form is k/a Ogilvie syndrome*) Acute form usually involves only the colon.\nVomiting appears late or even absent.\nAbd. cramps appear late.\nAbd. distention is the chief symptom.\nSince it usually involves the colon air-fluid level are not seen if the ileocecal valve is intact.\n\n\nPoints c, d, e help in ruling out Pseudo obstruction in this pt.\n\nCa Rectum : \n\nUsually ads. of old age\nObstruction is not a common presentation Even if obstruction occurs, it is insidious in onset with pain & vomiting a late feature. There will be abdominal distention.\nThese point help in ruling Ca Rectum out.\n\nDuodenal obstruction\n\nFeatures of this pt. match perfectly with duodenal obstruction as\nPain and vomiting are early features.\nNo distention of the bowel\nNo air-fluid level. (There is no distention of bowel and no air fluid level as the whole of the intestinal tract distal to the obstruction is patent allowing free passage to gas and the fluids out of the body. Obstruction to duodenum prevent further entry of gas or fluids into the intestines).", 'role': 'assistant'}]