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General Surgery > Intestines and Appendix > Flashcards

Intestines and Appendix Flashcards

1
Q

The portion of the small intestine that absorbs amino acids, disaccharides, iron and electrolytes:

(1) duodenum
(2) jejunum
(3) ileum

A

The (1) duodenum is the portion of the small intestine that absorbs amino acids, disaccharides, iron and electolyes.

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2
Q

The portion of the small intestine that absorbs fatty acids, minerals, folate and vitamins A, D, E and K

(1) duodenum
(2) jejunum
(3) ileum

A

The (2) jejunum is the portion of the small intestine that absorbs fatty acids, minerals, folate and vitamins A, D, E and K.

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3
Q

The portion of the small intestine that absorbs vitamin B12, intrinsic factor and bile acids:

(1) duodenum
(2) jejunum
(3) ileum

A

The (3) ileum is the portion of the small intestine that absorbs vitamin B12, intrinsic factor and bile acids.

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4
Q

The blood supply to the duodenum is the:

(1) superior mesenteric artery
(2) inferior mesenteric artery
(3) inferior vena cava

A

(1) superior mesenteric artery and the superior mesenteric vein.

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5
Q

T/F: the jejenum has fewer vascular arcades compared to the rectum.

A

True.

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6
Q

The enzymes responsible for the final digestion of starch molecules are concentrated in the:

A

brush border of the luminal surface.

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7
Q

T/F: glucose and galactose are absorbed by active transport and fructose is absorbed through facilitated diffusion.

A

True.

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8
Q

In the small intestine, proteins come in contact with proteases. These proteases are from:

A

the pancreas.

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9
Q

Dietary fat and unconjugated bile acids are absorbed in the:

(1) duodenum
(2) jejunum
(3) ileum

A

Dietary fat and unconjugated bile acids are absorbed in the (2) jejunum.

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10
Q

T/F: medium chain fatty acids require chylomicrons for absorption.

A

True.

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11
Q

Which of the following is digested or absorbed by the small intestine?

(1) sodium and chloride
(2) calcium
(3) iron
(4) fat and water soluble vitamins
(5) all of these

A

(5) All of these

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12
Q

CCK is responsible for

A

stimulating pancreatic enzyme secretion, bicarbonate secretion and gallbladder contraction.

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13
Q

Somatostatin is responsible for

A

inhibiting motility and gastrin release.

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14
Q

PIP is a neuropeptide that is responsible for

A

pancreatic and intestinal secretion.

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15
Q

Peyer’s patches, lamina propria lymphoid cells and intra-epithelial lymphocytes in the small intestine are used for

A

immune function

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16
Q

One of the major protective immune mechanisms for the intestinal tract is the synthesis and secretion of

A

IgA

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17
Q

The MOST common cause of small bowel obstruction is:

(1) adhesions and extraluminal etiologies.
(2) processes intrinsic to the bowel wall (e.g., primary tumors).
(3) intraluminal obturator obstruction (gallstones, enteroliths, foreign bodies etc).

A

The MOST common cause of small bowel obstruction is (1) adhesions and extraluminal etiologies.

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18
Q

In small bowel obstruction, intestinal fatigue and bowel dilation occur during:

A

Late stage

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19
Q

A patient with bowel obstruction is MOST likely to present with:

(1) fever
(2) polyuria
(3) hypotension and shock

A

(3) hypotension and shock

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20
Q

T/F: a small bowel obstruction does not result in increased venous return, elevaiton of the diaphragm or compromised ventilation.

A

False.

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21
Q

A patient presents with abdominal pain and nausea. The patient appears sweaty and dehydrated and has a low blood pressure. The patient is diagnosed with small bowel obstruction. The patient is also likely to present with:

(1) no bacterial translocation.
(2) compression of venous return

A

(2) compression of venous return.

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22
Q

Small bowel obstruction has cardinal symptoms of

(1) hypertension
(2) diarrhea
(3) colicky abdominal pain and constipation.

A

(3) colicky pain and constipation.

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23
Q

You auscultate the bowel of a patient with small bowel disease. There are hyperactive bowel sounds with audible rushes associated with peristalsis (borborgymi) the stage of small bowel obstruction is MOST likely:

A

late stage small bowel obstruction.

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24
Q

Palpation of an abdomen with small bowel obstruction will MOST likely reveal:

A

MILD abdominal tenderness with or without a palpable mass.

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25
Q

A patient with small bowel obstruction will MOST likely reveal on palpation of the abdomen:

(1) mild abdominal tenderness
(2) incarcerated hernia
(3) localized tenderness, rebound and guarding.
(4) intraluminal masses/stool for occult blood.

A

(1) mild abdominal tenderness with or without a palpable mass.

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26
Q

“stack of coins sign”, small bowel air entrapment and pligate circularis are examples of CXR findings consistent with

A

small bowel obstruction

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27
Q

Which of the following regarding small bowel obstruction is TRUE?

(1) most patients have strangulating obstructions
(2) SImple bowel obstruction involve mechanical blockage of the flow of luminal conents with compromise to the itnestinal wall.
(3) Strangulating involves a closed loop and intestinal infarction.

A

(3) strangulating involves a closed loop and intestinal infarction.

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28
Q

T/F: bowel ischemia and strangulation cannot be reliably diagnosed PRE-OP in all cases by any known clinical parameter or combination of parameters.

A

True.

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29
Q

Treatment for small bowel obstruction includes Ringer’s lactate. This:

A

an isotonic saline solution.

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30
Q

Which of the following is treatment for small bowel obstruction?

(1) Isotonic saline
(2) Nasogastric tube decompression
(3) operative intervention if there is a complete bowel obstruction.
(4) all of these.

A

(4) all of these.

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31
Q

The imaging modality for acute post-operative small bowel obstruction

A

CT scans

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32
Q

T/F: both partial reobstruction and complete re-obstruction require another surgical correction.

A

False.

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33
Q

Ileal obstruction is defined as:

(1) complete absence of passage of luminal contents with a mechanical obstruction.
(2) Reuslts from drug-induced etiologies only.
(3) Treatment is surgery and hsould not involve nasogastric decompression.

A

Ileal obstruction is the (1) complete absence of passage of luminal contents with a mechanical obstruction.

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34
Q

Ileal small bowel obstruction can be caused by:

(1) post laparotomy
(2) metabolic and electrolyte derangements.
(3) drugs
(4) intra-abdominal infections.
(5) All of these

A

(5) All of these.

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35
Q

A patient presents with colicky abdominal pain and increased bowel sounds. Labs show small bowel dilation and no dilation in the large bowel. You treat with NG tube suction, IV fluids and surgical exploration. The patient MOST likely has:

A

small bowel obstruction.

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36
Q

A patient presents with abdominal pain and minimal abdominal sounds. The patient had recent surgery and presents with hypokalemia. Lab/simaging show small bowel dilation and large bowel dilation. You treat the underlying cuase. The patient MOST likely has:

A

Paralytic ileus

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37
Q

Which of the following regarding small intestine neoplasms is TRUE?

(1) carcinoid is the most common type.
(2) Most patients are under 60 years old
(3) females have a higher incidence than males.

A

(1) Carcinoid is the most common type of small intestine neoplasms.

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38
Q

T/F: the GI tract is the most common site for carcinoid tumors.

A

True.

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39
Q

In the small intestine, carcinoids almost always occurs within the last 2 feet of the:

(1) duodenum
(2) jejunum
(3) ileum

A

(3) ileum

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40
Q

Carcinoid tumors arise from:

A

enterochromaffin cells found in the crypts of LIeberkuhn.

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41
Q

The type of carcinoid tumor that presents the HIGHEST levels of serotonin and substance P:

(1) foregut
(2) midgut
(3) hindgut

A

(2) Midgut

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42
Q

Which of the following regarding small intestine neuroendocrine tumors is TRUE?

(1) 70 - 80% of carcinoids are symptomatic and are found before operation.
(2) More than 90% of carcinoids are found in the appendix, ileum and rectum.
(3) Synchronous adenocarcinoma is seen in with all carcinoid tumors.

A

(2) More than 90% of carcinoids are found in the appendix, ileum and rectum.

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43
Q

A patient presents with a small bowel tumor. The patient presents with cutaneous flushing, diarrhea, hepatomegaly and cardiac lesions. You note that the patient is also at risk of malabsorption and pellagra. The type of carcinoid tumor the patient MOST likely has is:

A

malignant carcinoid syndrome.

44
Q

Carcinoid syndrome presents with:

(1) Cutaneous flushes with no cyanosis.
(2) constipation
(3) hepatomegaly, and retroperitoneal and pelvic fibrosis.

A

(3) hepatomegaly and retroperitoneal and pelvic fibrosis.

45
Q

A patient with small intestine neuroendocrine tumors may be diagnosed via:

(1) serotonin (HIAA)
(2) Chromogranin A (CgA)
(3) all of these

A

(3) All of these

46
Q

T/F: Neuroendocrine tumors of the small intestine can be diagnosed via HIAA. This test is highly specific, but not very sensitive.

A

True.

47
Q

A patient presents with small intestine neuroendocrine tumors. For primary tumors < 1 cm in diameter without evidence of regional lymph node metastasis:

A

A segmental intestinal resection is adequate.

48
Q

A patient presents with small intestine neuroendocrine tumors > 1 cm in diameter. Treatment should involve:

A

wide excision of the bowel and mesentery.

49
Q

Anesthesia should be avoided in treatment of small intestine neuroendocrine tumors because:

A

It may precipitate a carcinoid crisis characterized by hypotension, bronchospasm, flushing and tachycardia; predisposing to arrhythmias.

50
Q

A patient has small intesine neuroendocrine tumors. You the put the patient under anesthesia and they start to exhibit a carcinoid crisis. Treatment of this condition is

A

IV octreotide.

51
Q

T/F: Cytotoxic chemotherapy is the gold standard of treatment for metastatic small intestine neuroendocrine tumros.

A

False.

52
Q

Which of the following regarding diverticular disease is TRUE?

(1) A true diverticulum consists of the submucosa and mucosa protruding through a defect in the muscle coat and are acquired defects.
(2) Duodenal diverticula are the most common acquired diverticula of the small bowel.
(3) Meckel’s diverticulum is a rare congenital diverticulum of the small bowel.

A

(2) Duodenal diverticula are the most common acquired diverticula of the small bowel.

53
Q

Small bowel ulcerations may be due to:

(1) Chron’s disease, typhoid fever, TB, lymphoma.
(2) KCL tablets, corticosteroids or NSAIDs.
(3) All of these

A

(3) All of these.

54
Q

An enterocutaneous fistula is usually the result of:

A

surgical misadventure.

55
Q

T/F: The more proximal the enterocutaneous fistula, the more serious the problem with greater fluid and electrolyte loss.

A

True.

56
Q

A patient presents with dehydration and depletion of fluids and electrolytes. There is necrosis of the skin around the duodenal area. In order to rule out an enterocutaneous fistula, imaging should involve:

A

CT scan with contrast (inject contrast dye through the fistula tract).

57
Q

A patient with an enterocutaneous fistula presents with output of 750 ml/24 hours. There is 75% circumference disruption of the intestinal continuity. The fistula tract is 2.0 cm. According to these findings the fistula is:

A

Unlikely to close.

58
Q

Which of the following symptoms is NOT associated with enterocutaneous fistula?

(1) Foreign body in tract
(2) radiation enteritis
(3) Drained abscess with no infection.
(4) Epithelialization of the fistual tract
(5) Neoplasm (cancer)
(6) Distal obstruction

A

(3) drained abscess with no infection.

59
Q

Successful management of enterocutaneous fistulas involves:

A

Managemnent of damage, sepsis and prevention of fluid/electrolyte depletion, protection of skin, provision of adequate nutrition.

60
Q

Surgical management of an enterocutaneous fistula should be considered:

A

After conservative therapy for 4 - 6 weeks has not improved symptoms.

61
Q

A patient presents with diarrhea and steatorrhea. The patient has noticed weight loss and abdominal pain. Labs shows bacterial overgrowth in the bowel secondary to stenosis. You diagnose the patient with blind loop syndrome. Conservative treatment is:

A

vitamin B therapy.

62
Q

A patient with blind loop syndrome is scheduled for surgical correction of the deformity. This is indicated in patients who:

A

Require multiple rounds of antibiotics.

63
Q

A patient is MOST likely to experience symptoms (diarrhea, abdominal pain and malabsorption) from radiation enteritis if the radiation exposure:

A

exceeds 5000 cGy.

64
Q

Damage to the small submucosal blood vessels is seen in radiation enteritis when:

A

Late and severe stages of radiation enteritis.

65
Q

Which of the following regarding short bowel syndrome is TRUE?

(1) It results from a total small bowel length that is adequate to support nutrition.
(2) Most cases occur from massive intestinal resection.
(3) In neonates, it is not associated with necrotizing enterocolitis.
(4) All patients are permanently dependent on TPN.
(5) Distal bowel resection is tolerated much better than proximal resection.

A

(2) Most cases occur from massive intestinal resection.

66
Q

The clinical hallmarks of short bowel syndrome include:

A

diarrhea, fluid and electrolyte disturbances, as well as malnutrition.

67
Q

Early phase treatment of short bowel syndrome involves:

A

control of diarrhea, replacement of fluid and electrolytes and the prompt institution of TPN.

68
Q

T/F: bacteriology peritoneal cultures will be positive in more than 85% of patients with gangrenous or perforated appendicitis.

A

True.

69
Q

The diagnosis of appendicitis is primarily based on:

(1) clinical history and physical findings.
(2) labs and imaging
(3) surgical exploration.

A

(1) Clinical history and physical findings.

70
Q

Imaging is used for diagnosis of appendicitis in:

A

Children and pregnant women.

71
Q

T/F: A completely normal leukocyte count and differential is uncommon in patients with appendicitis.

A

True.

72
Q

Before surgery, appendicitis treatment should involve:

A

fluid resuscitation.

73
Q

A patient who is indicated for urgent appendectomy has:

A

acute, non-perforated appendicitis.

74
Q

Antibiotics used for appendicitis should contain coverage of:

A

enteric anaerobic and gram negative bacteria.

75
Q

A patient has appendicitis. Imaging shows that there is fecal impaction (fecalith). Treatment should involve:

A

appendectomy.

76
Q

A patient presents with a perforated appendicitis with peritonitis. Prior to performing an appendectomy, you should take note to:

A

adequately resuscitate the patient and provide broad-spectrum antibiotics (negative aerobes and anaerobes).

77
Q

The preferred approach to the management of appediceal mass (abscess is)

A

Percutaneous drainage (use US or CT to guide this) as well as IV antibiotics directed against aerobic gram negative and anaerobic organisms.

78
Q

A pregnant patient presents with appendicitis. Treatment should invovle:

A

early surgical intervention in all trimesters.

79
Q

A patient with Chron’s disease presents with appendicitis. Treatment should involve:

A

appendectomy.

80
Q

Appendix carcinoid tumors are derived from

A

midgut argentaffin cells of neural crest origin.

81
Q

T/F: Carcinoids are the most common appendiceal neoplasms.

A

True.

82
Q

A patient presents with a 2.5 cm appendiceal carcinoid tumor. The treatment of this should involve:

A

Simple appendectomy; however note that the lesion size has a higher incidence of distant metastases adn a right hemicolectomy may be necessary.

83
Q

The blood supply of the colon is the:

A

superior mesenteric artery and inferior mesenteric artery.

84
Q

The anastomosis or linking of arcades between the superior and inferior mesenteric vessels of the colon is known as the:

A

Arc of Riolan

85
Q

T/F: between 1000 and 1500 ml of fluid is poured into the cecum by the daily ileal effluent, making it the most efficient site of absorption in the GI tract per surface area.

A

True.

86
Q

The colonic mucosa absorbs

A

Bile acids and water

87
Q

The gastrocolic reflex refers to:

A

the effects of a meal on colonic motility; they can be prasympathetic and sympathetic.

88
Q

The Auerbach’s plexus is a set of nerves in the colon located in the:

A

Muscularis propria

89
Q

The main source of energy for intestinal flora are:

A

cmoplex carbohydrates (dietary fiber)

90
Q

The main organism in the colon is:

A

bacteroides

91
Q

Which of the following regarding diverticular disease is TRUE?

(1) It is prevalent in countries with Low intake of dietary fiber.
(2) It results when there is too much “bulk” in the colon, causing herniations of the mucosa.
(3) True and false diverticula are the same things.
(4) Younger people are more likely to have diverticula than older people.

A

(1) It is prevalent in countries with a low intake of dietary fiber.

92
Q

The MOST common site for diverticulum formation in the colon is:

A

sigmoid colon.

93
Q

Which of the following regarding diverticular disease is TRUE?

(1) they do not coexist with other colonic pathologies.
(2) THey are most common in the right side of the colon.
(3) They occur frequently in the rectum.
(4) complications are inflammation, bleeding and perforation/fistulization of the bladder.

A

(4) Complications are inflammation, bleeding and perforation/fistualization of the bladder.

94
Q

Indications for surgical correction of diverticular disease are:

A

peritonitis, closed loop obstruction, multiple episodes of uncomplicated acute diverticulitis, presence of colonic fistual.

95
Q

The first line treatment for acute diverticular disease is:

A

IV antibiotic therapy

96
Q

Cecal volvulus presents with:

A

bird’s beak image representing the point of torsion.

97
Q

The MOST common type of colonic volvulus is:

A

Sigmoid volvulus (> 90%).

98
Q

Megacolon, concomitant laxative abuse, Ogilvie’s syndrome and Chaga’s disease are all associated with:

A

Sigmoid volvulus.

99
Q

T/F: surgical resection of a sigmoid volvulus is only indicated for emergency cases.

A

False.

100
Q

T/F: operation for cecal volvulus is urgent.

A

True.

101
Q

Which of the following regarding colon cancer is TRUE?

(1) It is the leading cause of cancer deaths in the USA for both men and women.
(2) Genetics is the most common etiology.
(3) Majority are adenocarcinoma/sporadic.

A

(3) The majority of colon cancers are adenocarcinoma/sporadic.

102
Q

A patient presents with colorectal cancer. The development of the condition is a process that takes:

A

10 - 15 years and evolves from initiation through well-defined phases of progression.

103
Q

The earliest expression of neoplastic change in colorectal cancer is

A

aberrant crypt foci.

104
Q

A patient presents with colorectal polyps on a recent colonoscopy. The polyps should be:

A

completely excised or undergo biopsy to assess the malignant potential.

105
Q

Adenomatous polyps can be tubular, villous or tubulovillous. The type of polyp that contain malignant potential:

A

all adenomatous polyps contain malignant potential.

106
Q

The extent of colon resection in colorectal cancer is determined by:

A

location of the tumor, blood supply and draining lymphatic vessels; as well as the presence or absence of direct extension into adjacent organs.

107
Q

When treating colorectal cancer, radiation therapy:

A

is helpful but makes urgery more challenging.

General Surgery (12 decks)

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