Tắc Ruột Non-bệnh Học

The most common cause of small bowel obstruction is adhesions formed after surgery. These adhesions are bands of scar tissue that can develop between the intestines and the abdominal wall or other organs. They can cause the intestines to become twisted or blocked, leading to a bowel obstruction. This is a known complication of abdominal surgery and can occur weeks, months, or even years after the procedure.

In patients with small bowel obstruction, an increase in gas within the large intestine (colonic gas) suggests that the obstruction is progressing well. This is because the small bowel obstruction prevents the passage of gas into the large intestine, causing a buildup of gas in the colon. Therefore, if the X-ray shows an increase in colonic gas compared to the initial X-ray, it indicates that the obstruction is progressing well and the patient's condition is improving.

The correct answer is D - Hoại tử thành ruột. This is because in thắt nghẹt ruột (intestinal obstruction), the blood supply to a section of the intestine is cut off, which can lead to tissue death (necrosis) in that area. This does not occur in tắc ruột đơn thuần (simple constipation), where there is a blockage in the intestine but the blood supply is not compromised.

The correct answer is E - Câu A, B, C đúng. This means that all of the following characteristics are true for an obstructive bowel obstruction: the intestine is blocked, the arterial blood supply is blocked, and the venous blood flow is blocked.

The first differential diagnosis for high bowel obstruction is usually volvulus, which is the twisting or kinking of the bowel causing a blockage. This can lead to a closed-loop obstruction and can be a surgical emergency if not treated promptly.

The correct answer is B-X-quang bụng. X-ray of the abdomen is the initial imaging modality recommended for patients with small bowel obstruction. It can help identify the presence and location of the obstruction, as well as any signs of bowel perforation or other complications. Other imaging modalities like ultrasound, CT scan, and endoscopy may be used to further evaluate the obstruction if needed, but X-ray is typically the first step in diagnosis.

The correct answer is C because the presence of gas in the small bowel can be seen on an upright abdominal X-ray but not on a supine abdominal X-ray. This is because the gas rises to the top of the bowel when the patient is standing, creating a level of air-fluid levels that can be visualized. This is known as the "gas pattern" and can help diagnose conditions such as small bowel obstruction.

The correct answer is A because in cases of intestinal obstruction, a standing abdominal X-ray is not able to differentiate between obstruction in the distal colon and obstruction caused by a tumor in the ascending colon.

CT scan is not typically indicated in cases of incarcerated hernia, also known as abdominal wall hernia. Incarcerated hernia occurs when a portion of the intestine or other tissue becomes trapped within the abdominal wall, causing obstruction. CT scan is not necessary for diagnosis in these cases, as the physical examination findings and symptoms are usually sufficient. Instead, other imaging modalities such as ultrasound or plain radiography may be used to confirm the diagnosis.

The correct answer is B-Phẫu thuật vùng dưới rốn. This is because surgery in the lower abdomen (below the navel) carries a higher risk of causing adhesions or intestinal obstruction. The proximity to the intestines and the manipulation of the abdominal organs during surgery increase the likelihood of adhesions forming, which can lead to bowel obstruction.

The correct answer is A because the diagnosis and differentiation between complete early small bowel obstruction and partial small bowel obstruction can be challenging in clinical practice. Both conditions present with similar symptoms such as abdominal pain, distension, and vomiting. Further diagnostic tests such as imaging studies may be required to accurately differentiate between the two conditions.

The correct answer is B because primary malignant tumors of the small intestine are rare. The majority of small intestine obstructions are caused by benign conditions such as adhesions, hernias, or inflammatory diseases. Secondary malignant tumors or metastases from other primary cancers are more common than primary malignant tumors of the small intestine.

The most common cause of postoperative bowel paralysis is the use of medications that inhibit bowel motility. These medications can include opioids, which are commonly used for pain control after surgery. Opioids can slow down the movement of the intestines, leading to constipation or even a complete paralysis of the bowel. This can result in symptoms such as bloating, abdominal pain, and the inability to pass stool or gas. Therefore, the use of medications with side effects that inhibit bowel motility is the most likely cause of postoperative bowel paralysis.

Siêu âm có giá trị chẩn đoán tắc ruột non cao hơn X-quang bụng khi bệnh nhân đến sớm vì trong giai đoạn đầu của tắc ruột non, các biểu hiện lâm sàng và các dấu hiệu trên siêu âm thường rõ ràng hơn so với X-quang bụng. Trong trường hợp tắc ruột non, nếu bệnh nhân đến muộn, dấu hiệu trên X-quang bụng có thể không đủ để chẩn đoán chính xác và siêu âm sẽ cung cấp thông tin chi tiết hơn để đưa ra chẩn đoán.

The correct answer is B because it states that intestinal obstruction caused by constriction is usually complete. This means that the blockage in the intestine completely prevents the passage of any material, leading to a complete obstruction.

The correct answer is D - Dấu rắn bò. "Dấu rắn bò" refers to the presence of ribbon-like stools, which is a characteristic symptom of small bowel obstruction. Small bowel obstruction occurs when there is a blockage in the small intestine, leading to symptoms such as abdominal pain, cramping, and distension. The other options listed (A, B, C, and E) may be associated with various gastrointestinal conditions, but they are not specific to small bowel obstruction.

The symptoms of vomiting in patients with high intestinal obstruction differ from the symptoms of vomiting in patients with gastric outlet obstruction in terms of the quantity of vomitus, the color of vomitus, and the circumstances in which vomiting occurs. Therefore, options A, B, and C are all correct.

The differential diagnosis between simple small bowel obstruction and volvulus in the early stage of the disease primarily relies on the characteristic of pain.

If there is no palpable abdominal mass in a patient with bowel obstruction and no previous surgical scar, it is appropriate to order a CT scan or abdominal ultrasound to aid in the diagnosis. This is because imaging studies can help identify the cause of the obstruction and guide further management. Therefore, option A is the correct answer.

The correct answer is B: Dấu hiệu chướng bụng. Both acute small bowel obstruction and acute colonic pseudo-obstruction can present with abdominal distension or bloating. This is due to the accumulation of gas and fluid in the intestines, leading to increased pressure and stretching of the abdominal wall. Other symptoms such as abdominal pain, dehydration, and vomiting may also be present in both conditions, but abdominal distension is a common feature that is shared between the two.

The differential diagnosis between late-stage small bowel obstruction and primary colonic obstruction is mainly based on X-ray signs. This means that X-ray imaging can help distinguish between these two conditions by identifying specific abnormalities in the affected area of the intestine. The other options listed (abdominal pain, distended abdomen, floating bowel sign, and crawling sign) may be present in both conditions, but X-ray findings can provide more definitive evidence for accurate diagnosis.

The correct answer is C-50-70. This means that X-ray of the abdomen has an accuracy rate of approximately 50-70% in diagnosing small bowel obstruction.

The correct answer is E because it states that both statements B and C are true. Statement B says that the patient with partial intestinal obstruction still has bowel movements when admitted to the hospital. Statement C says that the patient with partial intestinal obstruction experiences less nausea and vomiting.

Tắc hỗng tràng khác tắc hồi tràng ở việc các cơn đau bụng quặn thường xảy ra thưa hơn.

The correct answer is C. The difference between a malignant tumor of the colon or rectum and a benign tumor of the intestine in adults is that a malignant tumor can be felt when touched, while a benign tumor cannot be felt.

The most prominent clinical condition when a patient is admitted with high bowel obstruction is fatigue due to dehydration and electrolyte imbalance.

The correct answer is E - Câu A,B,C sai. This means that none of the statements A, B, and C are correct. The question is asking about the characteristics of a non-encapsulated tumor, and the correct answer states that none of the given statements are true.

The correct answer is A because early non-obstructive bowel obstruction is not an indication for a CT scan. CT scans are typically ordered for cases of bowel obstruction caused by hernias, tumors, or volvulus (twisting of the intestine). In cases of early non-obstructive bowel obstruction, other diagnostic tests such as X-rays or ultrasound may be more appropriate.

The correct answer is C - Dấu rắn bò. This is because "dấu rắn bò" refers to the presence of snake-like movements in the abdomen, which is not a characteristic sign of bowel obstruction. The other options, including "dấu chướng bụng" (abdominal distension), "dấu quai ruột nổi" (visible peristalsis), "dấu gồng cơ thành bụng" (guarding), and "dấu nhiễm trùng-nhiễm độc" (signs of infection/toxicity), are all associated with bowel obstruction.

The presence of gas in the colon can help differentiate between obstruction and partial obstruction of the small intestine. In cases of obstruction, gas cannot pass through the blocked area and accumulates in the small intestine, resulting in a lack of gas in the colon. In contrast, in cases of partial obstruction, gas can still pass through the blocked area, leading to the presence of gas in the colon. Therefore, the presence or absence of gas in the colon on abdominal X-ray can be used to distinguish between obstruction and partial obstruction of the small intestine.

The most common clinical symptom of small bowel obstruction is abdominal cramping pain. This pain is typically described as a colicky or cramp-like sensation and is caused by the blockage of the small intestine, which leads to increased pressure and stretching of the bowel. Other symptoms may include bloating, nausea, vomiting, and diarrhea. However, abdominal cramping pain is the most frequently reported symptom in cases of small bowel obstruction.

When a patient is admitted for intestinal obstruction, if the abdominal X-ray shows a small amount of gas in the colon, the diagnosis on the X-ray will be partial small bowel obstruction. This is because in cases of complete small bowel obstruction, there would be no gas in the colon. Therefore, the presence of a small amount of gas in the colon indicates that the obstruction is not complete and there is still some gas passing through the intestines.

The correct answer is D because both options A and C are correct. Option A states that the patient still has fecal matter in their colon after being admitted to the hospital, which is a characteristic of partial bowel obstruction. Option C states that an X-ray of the abdomen shows air still present in the colon, which also supports the diagnosis of partial bowel obstruction. Therefore, both options A and C being correct makes the diagnosis of partial bowel obstruction highly likely.

The correct answer is E because in cases of complete small bowel obstruction, both in the early and late stages, signs of snake-like stool can appear. This is due to the accumulation of stool in the intestines, causing it to form a shape similar to that of a snake. Therefore, both options A and D are correct.

The correct answer is B because lồng ruột non ở người lớn (intussusception in adults) is usually caused by benign (u lành tính) conditions, such as polyps or tumors in the intestine. Intussusception occurs when one segment of the intestine slides into the adjacent segment, causing a blockage. While it is more common in children, it can also occur in adults, and in most cases, it is not caused by malignant (u ác tính) tumors.

In the early stages of small bowel obstruction, the abdominal pain caused by the increased contractions of the intestine will occur at intervals of 4-5 minutes.

The correct answer is C because when the intestinal walls become stretched or distended, it can cause a blockage in the small intestine. This can lead to symptoms such as abdominal pain, bloating, and constipation.

The earliest sign of non-obstructive ileus due to constriction is the presence of localized swelling in one segment or loop of the intestine. This can be observed on a CT scan of the abdomen.

The correct answer is A because the question is asking for a differentiating characteristic of high intestinal obstruction compared to gastric obstruction. Option A states that the patient with high intestinal obstruction will have frequent and continuous vomiting, which is not seen in gastric obstruction. The other options do not provide characteristics specific to high intestinal obstruction.

The most common symptom in patients with small bowel obstruction is abdominal distension, which is characterized by a bloated or swollen abdomen. This occurs when the intestines become blocked, preventing the passage of food, fluid, and gas. As a result, the abdomen becomes distended and can cause discomfort or pain. This symptom is often accompanied by other signs such as nausea, vomiting, constipation, and inability to pass gas.

The correct answer is D because in acute colonic obstruction, there is a build-up of gas in the colon due to the blockage. This can lead to distension of the colon, causing it to contain more gas than usual. In contrast, in small bowel obstruction, there is typically more air-fluid levels seen on X-ray due to the accumulation of fluid and gas in the dilated small intestine.

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The correct answer is D because the presence of gas in the colon on abdominal X-ray is a characteristic finding in partial intestinal obstruction. This can occur due to a blockage in the small intestine, leading to the accumulation of gas in the colon. The other options (A, B, C, and E) do not describe specific findings associated with partial intestinal obstruction.

When an intestinal obstruction occurs, both the section of the intestine above the blockage and the section below the blockage will experience increased contractions. This is because the blockage prevents the normal flow of food and waste through the intestine, leading to a buildup of pressure and increased muscle contractions in an attempt to push the contents past the obstruction.

The correct answer is B-X-quang đại tràng. This is because X-quang đại tràng is a method used to diagnose large bowel obstruction, not small bowel obstruction. The other methods listed are all used to diagnose small bowel obstruction.

Patients with intestinal obstruction or partial obstruction will have symptoms such as abdominal distention, constipation, and vomiting. Option C states that there is constipation without abdominal distention, which contradicts the symptoms of intestinal obstruction. Therefore, this symptom does not occur in patients with intestinal obstruction or partial obstruction.

The correct answer is A-Hội chứng tắc ruột non mãn tính. This is because the question is asking about the clinical presentation of the small bowel obstruction in adults, and the correct answer describes the chronic form of this condition.

The correct answer is D - Câu A,C đúng. This means that when it is stated that ultrasound has a 100% specificity in diagnosing simple intestinal obstruction, it implies that no case of intestinal obstruction is missed by ultrasound and all cases that ultrasound diagnoses as intestinal obstruction are indeed intestinal obstruction.

If the patient has signs of bowel obstruction such as a distended abdomen and the presence of bowel sounds, it would support the diagnosis of small bowel obstruction. This is because in small bowel obstruction, the bowel becomes distended with gas and fluid, leading to a distended abdomen. The presence of bowel sounds indicates that there is still some movement of the bowel, suggesting that the obstruction is not complete. Therefore, if the patient has a distended abdomen with bowel sounds, it would not exclude the diagnosis of small bowel obstruction.

The correct answer is E - Câu A,B,C sai. This means that none of the options A, B, or C are true. The question is asking for the difference between the colon and the small intestine. However, options A, B, and C do not provide accurate differences between the two.