Faeculent Vomiting Significance — SCE Palliative Medicine MCQ
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Correct answer: A — Distal small bowel or large bowel obstruction — bacterial overgrowth in the obstructed segment produces faeculent material that is refluxed and vomited
Explanation lettering: E = shown as B · B = shown as E
Faeculent (stercoraceous) vomiting is a recognized sign of distal small bowel or large bowel obstruction in palliative care. As obstruction progresses, luminal contents stagnate and are converted by colonic bacterial overgrowth into malodorous material that is vomited retrogradely. This mechanism is described in current Scottish Palliative Care Guidelines and other UK palliative protocols. Other options are less plausible: a fistula (B) is exceedingly rare without prior surgical history; medications do not produce a faeculent odour (C); ingesting stool (D) is unlikely and not consistent with usual pathophysiology; gastric cancer itself (E) does not produce this specific vomiting unless causing downstream obstruction.
Reference: Scottish Palliative Care Guidelines: Bowel Obstruction (Healthcare Improvement Scotland, current); Northern Cancer Alliance Palliative and End of Life Care Guidelines – Bowel Obstruction section (2016), UK. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/symptom-management/bowel-obstruction/