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 women of 35-year old comes to emergency depament with symptoms of pain in abdomen and bilious vomitting 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: Ans is 'b' ie Duodenal obstruction Lets see each option one by one Adynamic ileus or Paralytic ileus a) is seen commonly after abdominal operations, or post inflammatory conditions of abdomen eg Appendicitis, peritonitis, pancreatitis. Metabolic abnormalities are also a cause. b) Abdominal distention, usually without the colicky abdominal pain, is the typical & most notable finding. c) Vomiting may occur but may also be absent. d) Absent or hypoactive bowel sounds. e) Multiple air fluid levels on x-ray. Points b & e help in ruling out adynamic ileus. Pseudoobstruction a) This condition describes an obstruction, usually of the colon in the absence of any mechanical cause b) This may occur in acute or chronic form (Acute form is k/a Ogilivie syndrome*) Acute form usually involves only the colon. c) Vomitting appear late or even absent. d) Abd. cramps appear late. e) Abd. distention is the chief symptom. f) Since it usually involves the colon air fluid level are not seen if the ileo-cecal valve is intact. Points c, d, e help in ruling out Pseudoobstruction in this pt. Ca Rectum : a) Usually a ds. of old age b) Obstruction is not a common presentation Even if obstruction occurs, it is insiduous in onset with pain & vomiting a late feature. There will be abdominal distention. These point help in ruling Ca Rectum out. Duodenal obstruction Features of this pt. match perfectly with duodenal obstruction as Pain and vomitting are early features. No distention of bowel No air fluid level. (There is no distention of bowel and no air fluid level as whole of the intestinal tract distal to the obstruction is patent allowing free passage to gas and the fluids out of body. Obstruction to duodenum prevent fuher entry of gas or fluids into the intestines).", 'role': 'assistant'}]