PAEA Surgery End Of Rotation (EOR) Practice Exam

What finding in a physical exam would suggest a small bowel obstruction?

1. Lethargy and normal skin turgor

2. Dehydration and hypotension

3. Normal bowel sounds and soft abdomen

4. Constipation and fever

The correct answer is: Dehydration and hypotension

A finding of dehydration and hypotension would indeed suggest a small bowel obstruction. In cases of small bowel obstruction, fluid accumulation occurs in the bowel proximal to the obstruction, leading to significant dehydration as the body cannot properly absorb fluid. This can result in a state of hypotension due to reduced intravascular volume. Additionally, patients with small bowel obstructions often experience nausea and vomiting, which further contributes to dehydration. As the obstruction progresses, there may be a shift in electrolyte balance and a decline in perfusion, which can manifest as hypotension. Thus, the presence of both dehydration and hypotension provides vital clues that align with the physiological responses seen in small bowel obstruction. Other options, such as lethargy with normal skin turgor or normal bowel sounds with a soft abdomen, would not typically align with the classic findings of an obstructive process, which usually exhibits signs of distress and altered bowel function. Likewise, the presence of constipation and fever could suggest different pathology but does not specifically indicate a small bowel obstruction. Overall, the dual finding of dehydration and hypotension is particularly indicative of this condition.