Online OSCEs - Station FOUR - Abdominal X-ray

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A 67 year-old women is admitted directly to the surgical ward at the request of her GP. She has persistent vomiting and has not passed a motion for 4 days.

An abdominal x-ray is performed, which is shown below:

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Question 1: What further question would you like to ask about her constipation? (1 mark)

Question 2: What would you expect her bowel sounds to be like? (1 mark)

Question 3: Describe the findings on this AXR (3 marks)

Question 4: What is the diagnosis? (1 mark)

Question 5: Give 3 causes for this diagnosis (3 marks)

Question 6: What are the treatment options? (2 marks)

Goto the Next Station.

Answers:

Answer 1:	What further question would you like to ask about her constipation? Is the constipation absolute? Ask the patient when they last pasted gas per rectum. (1 mark)
Answer 2:	What would you expect her bowel sounds to be like? Tinkling bowel sounds (1 mark). (High pitched in nature due to bowel obstruction).
Answer 3:	Describe the findings on this AXR. Dilated small bowel loops (1 mark) Located in the centre of the film/Valvulae conniventes seen (1 mark) No gas observed in rectum/large bowel (1 mark)
Answer 4:	What is the diagnosis? Small bowel obstruction (1 mark) (Distal small bowel obstruction due to multiple loops on film)
Answer 5:	Give 3 causes for this diagnosis. Surgical adhesions Congenital band Intussusception (most often children) Gallstone ileus Intra-luminal lesion (* One mark for any of the causes listed to a maximum of 3 marks.)
Answer 6:	What are the treatment options? Surgical (laparotomy to identify the cause and then surgically rectify the problem) (1 mark) Conservative ("Drip and Suck") (1 mark)