{"id":7518,"date":"2025-09-22T00:01:00","date_gmt":"2025-09-22T08:01:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=7518"},"modified":"2025-10-01T11:38:26","modified_gmt":"2025-10-01T19:38:26","slug":"usmle-step-1-question-of-the-day-dilated-bowel-loops","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dilated-bowel-loops","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Dilated bowel loops"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dilated-bowel-loops\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dilated-bowel-loops\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dilated-bowel-loops\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dilated-bowel-loops\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dilated-bowel-loops\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dilated-bowel-loops\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Can you determine the most likely diagnosis for a 65-year-old woman visiting the ER because of severe abdominal pain? Let&#8217;s find out!<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 65-year-old woman presents to the emergency department due to severe abdominal pain. Three months ago, the patient underwent uncomplicated abdominal surgery to resect a large uterine fibroid. Past surgical history is notable for a C-section and cholecystectomy. Temperature is 37.2\u00b0C (99.0\u00b0F), pulse is 100\/min, respirations are 22\/min, and blood pressure is 110\/60 mm Hg. On physical examination, high-pitched bowel sounds are heard on auscultation and there is guarding and diffuse abdominal tenderness with palpation. A CT of the abdomen and pelvis shows dilated loops of the small bowel with a transition point. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>What&#8217;s the cause of this patient\u2019s current disorder?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Malignancy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Paralytic ileus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Peritoneal adhesions<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Uterine leiomyomata<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Abscess from previous surgery<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the University College London, UK\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DIp3u0oTLo4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Peritoneal adhesions<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Malignancy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Malignancies can cause small bowel obstruction. However, given this patient\u2019s history of multiple abdominal surgeries, peritoneal adhesions are more likely the cause of SBO in this patient.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Paralytic ileus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Paralytic ileus occurs in the days following an abdominal operation. In contrast, this patient is several months out from her most recent abdominal surgery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Uterine leiomyomata<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Large uterine fibroids can potentially cause bowel obstruction, and while this patient has a history of uterine leiomyomata or fibroids, the mass was resected 3 months ago. Recurrence of uterine fibroids after surgery can occur within the first few years after removal, but they do not typically recur within months after surgery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Abscess from previous surgery<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> While an intra-abdominal abscess can lead to SBO, it would present with an air-fluid level on imaging as well as systemic signs such as fever, nausea, and vomiting. Most intra-abdominal abscesses occur within 1-3 weeks of surgery. It is rare for them to develop several months after surgery.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with diffuse abdominal pain, guarding, and pain with palpation in the setting of a history of multiple abdominal surgeries. Furthermore, physical examination reveals high-pitched bowel sounds, and CT imaging demonstrates dilated bowel loops with a transition point. In combination, these findings indicate a <strong>small bowel obstruction<\/strong> (SBO).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">While SBO can be caused by several factors, such as a space-occupying malignancy, infection, trauma, or irradiation, the vast majority are caused by <strong>peritoneal adhesions<\/strong>. Peritoneal adhesions form in 93 to 100% of patients following abdominal surgery. Adhesions are fibrous connective tissue bands analogous to scar tissue on the skin that form between two or more intra-abdominal organs and\/or the inner abdominal wall. These adhesions can cause a lattice of dense connective tissue throughout the abdominal cavity, making future surgical operations difficult. The adhesions can lead to <strong>strangulation of small bowel loops and SBO.<\/strong> They can lead to other complications including female infertility and chronic abdominal pain.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Small bowel obstruction is a significant complication of peritoneal adhesions which are dense bands of fibrous scar tissue that can develop after abdominal surgeries. They can lead to complications such as SBO, female infertility, chronic abdominal pain, and difficulties with future surgeries.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Read this Osmosis high-yield note:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Intestinal_adhesions\"><strong>Intestinal adhesions<\/strong><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Welle, N.J., Sajjad, H., Adkins, A., Burns, B. (2021) \u201cBowel adhesions\u201d. <em>StatPearls [Internet]<\/em>. Web Address: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470544\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470544\/<\/a>.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png?w=700\" alt=\"\" class=\"wp-image-4633\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis from Elsevier today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A patient with a history of abdominal surgery presents with severe abdominal pain and imaging showing dilated bowel loops. What are the possible causes?<\/p>\n","protected":false},"author":202,"featured_media":7520,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[1434,1432,440,1431,1429,1435,1430,1433,664],"class_list":["post-7518","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-abdominal-ct","tag-abdominal-pain","tag-emergency-medicine","tag-intestinal-adhesions","tag-peritoneal-adhesions","tag-postoperative-complications","tag-small-bowel-obstruction","tag-surgical-complications","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day:\u00a0Dilated bowel loops - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dilated-bowel-loops\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day:\u00a0Dilated bowel loops - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A patient with a history of abdominal surgery presents with severe abdominal pain and imaging showing dilated bowel loops. 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