PAEA Surgery End Of Rotation (EOR) Practice Exam

Which condition can mimic small bowel obstruction?

1. Acute diverticulitis

2. Paralytic ileus

3. Gastric outlet obstruction

4. Cholecystitis

The correct answer is: Paralytic ileus

Paralytic ileus is a condition in which there is a temporary cessation of bowel motility, leading to a functional obstruction of the intestines. This absence of peristalsis can present clinically similarly to a mechanical small bowel obstruction, with symptoms such as abdominal distention, cramping pain, nausea, and vomiting. In cases of paralytic ileus, while there is no physical blockage, the inability of the intestines to move properly can result in the buildup of gas and fluids, causing symptoms that are indistinguishable from those of true obstruction. Imaging studies may reveal distended loops of bowel, mimicking the appearance of small bowel obstruction. The other conditions listed can have similar abdominal symptoms, but they have distinct presentations and causes that differentiate them from a small bowel obstruction. Acute diverticulitis typically presents with localized pain and tenderness in the left lower quadrant and inflammation around diverticula. Gastric outlet obstruction manifests with vomiting of undigested food and early satiety, usually presenting with upper gastrointestinal symptoms rather than lower bowel symptoms. Cholecystitis, characterized by right upper quadrant pain and possibly referred pain to the shoulder, involves inflammation of the gallbladder and is associated with biliary symptoms rather than signs of bowel obstruction.