Gastroenterology MCQ Answer 19

Answer: b, c

The principles of management of a patient with small bowel obstruction include initial fluid resuscitation and restricting oral intake. The optimal fluid for resuscitation in this patient with a distal small bowel obstruction would likely be Ringer’s lactate or normal saline. Since gastric secretion is a small component of the fluid loss, potassium replacement is likely not particularly important. An indwelling urinary catheter should be placed to monitor the urine output to reflect the fluid status. Invasive hemodynamic monitoring with a central line is likely unnecessary unless concerns are raised about cardiac status. Nasogastric decompression is indicated in all but mild cases. The nasogastric tube serves to prevent distal passage of swallowed air and minimizes discomfort of reflux of intestinal contents and eliminates vomiting. There appears to be no clinical evidence suggesting the need for urgent operation and therefore resuscitation prior to surgery is of optimal importance in this patient.

It has been well established that perioperatively-administered antibiotics reduce wound infection and abdominal sepsis rates in patients undergoing operation to relieve intestinal obstruction, simple or strangulated. Once the decision has been made to proceed with surgery, broad spectrum antibiotics, covering gram-negative aerobes and anaerobes should be given. The use of antibiotics in patients who have not been committed to operation has not been evaluated systematically. Giving antibiotics to patients who are being observed can obscure the underlying process and, in the end, delay optimal therapy.

Category: Gastroenterology MCQs