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Small & Large Intestine > Potpourri > Flashcards

Potpourri Flashcards

1
Q

Disorder characterized by bacterial overgrowth of a segment of small intestine from a segment that is bypassed leading to diarrhea, steatorrhea, malnutrition, megaloblastic anemia (B12 deficiency)

A

blind loop syndrome

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2
Q

Diagnostic test for blind loop syndrome:

A

d-xylose test

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3
Q

Appearance of cystic pneumatosis intestinalis:

A

granular or foamy appearance that represents gas in the submucosa

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4
Q

Appearance of linear pneumatosis intestinalis:

A

consists of small bubbles within the muscular mucosa and subserosa to form a thin linear or curvilinear gas pattern outlining the wall of a segment of intestine

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5
Q

gold standard imaging modality to diagnosis intussusception

A

CT scan

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6
Q

Radiologic features of toxic megacolon:

A

cecal diameter >12cm or colonic dilation >6cm

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7
Q

Treatment of toxic megacolon:

A

total abdominal colectomy with end ileostomy

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8
Q

Output of a low output fistula:

A

<200cc/D

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9
Q

Output of intermediate output fistula:

A

200-500cc/D

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10
Q

Output of a high output fistula:

A

> 500cc/D

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11
Q

True or false. 4 day fixed course of IV abx isi as efficacious as longer duration treatment for intraabdominal abscess.

A

true

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12
Q

Medication that enhances GI recovery after colon surgery by antagonizing the peripheral effects of opioids on GI motility

A

alvimopan (Entereg)

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13
Q

when is operative management for a fistula indicated:

A

after failure of nonoperative management after a 6-8 week period

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14
Q

Risk factors for development of symptoms from a Meckel’s diverticulum:

A

male sex, age younger than 50, diverticulum length >2cm; presence of ectopic gastric tissue (strongest risk factor)

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15
Q

Complications of TPN and short gut syndrome:

A

metabolic bone disease, cholelithiasis, nephrolithiasis, liver disease, blood stream infections

yearly DEXA and routine LFTs indicated

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16
Q

99m technetium pertechnate scan for Meckels has an affinity for identification of____

A

gastric mucosa

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17
Q

antibiotic of choice for small bowel intestinal overgrowth

A

rifaximin

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18
Q

treatment of first uncomplicated episode of C. difficile:

A

oral metronidazole

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19
Q

treatment of recurrent C. difficile after receiving metronidazole:

A

oral vancomycin for 10 days

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20
Q

treatment of recurrent C. difficile after initial treatment with vancomycin:

A

pulse tapered oral vancomycin or oral fidaxomicin

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21
Q

treatment of multiple refractory C difficile episodes

A

fecal transplant

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22
Q

Treatment of Olgivies:

A

medical management initially and rule out mechanical obstruction
if unsuccessful, then neostigmine
if neostigmine unsuccessful, then colonic decompression

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23
Q

True or false. Incidentally discovered Meckels does not indicate need for resection.

A

true

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24
Q

True or false. Stomal necrosis that does not extend beyond/below the fascia still requires emergent intervention.

A

false

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25
Q

Most common complication of ileostomy reversal

A

SBO

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26
Q

Where is cholecystokinin produced?

A

I cells of duodenum and jejunum

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27
Q

What stimulates release of cholecystokinin?

A

fat, protein, and amino acid ingestion

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28
Q

What effects does cholecystokinin have?

A

increases antral and pyloric contraction, relaxes sphincter of Oddi, stimulates GB contraction, stimulates secretion of pancreatic enzymes

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29
Q

Condition associated with immunosuppression that is characterized by numerous polyps in the small and large intestine that consist of enlarged submucosal lymphoid follicles:

A

nodular lymphoid hyperplasia

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30
Q

Physiologic effects of using vasopressin to control GI bleed:

A

initiates arteriolar vasoconstriction and bowel wall contraction; side effects are MI, HTN, dysrhythmias, mesenteric thrombosis, simultaneous IV nitroglycerin is paramount to counteracting side effects

31
Q

For GI bleeds,_____ has largely replaced vasopressin infusion due to its complications and rebleeding rate.

A

transcatheter embolization

32
Q

Best test to confirm ischemic colitis:

A

endoscopy

33
Q

Injury of less than ___ of the circumference of the large intestine can be repaired primarily.

A

50%

34
Q

Preoperative albumin of less than ____ is a risk factor for anastomotic leak after colorectal surgery

A

<3.5g/dL

35
Q

True or false. COPD can cause pneumatosis intestinalis.

A

true

36
Q

Medications that can cause paralytic ileus:

A

opiates, antihistamines, alpha adrenergic agonists, anticholinergics

37
Q

____ is the most common complication of stricturoplasty.

A

Hemorrhage

38
Q

What is the colonoscopy screening regimen for a patient who has a 1st degree relative with an advanced adenoma, adenoma >1cm, or an adenoma with a villous component?

A

colonoscopy starting at age 40 or age of adenoma onset, whichever is first and then every 5-10 years if normal

39
Q

screning regiment for average risk patient of colon cancer:

A

colonoscopy at age 50 and every 10 years after that if normal

40
Q

True or false. External anal sphincter is under involuntary control

A

false

41
Q

Where does the external anal sphincter receive innervation from ?

A

inferior rectal branches of the pudendal nerve and the perineal branches of the fourth sacral nerve (S4)

42
Q

Primary fuel source of small bowel enterocytes

A

glutamine

43
Q

Primary fuel source for colonocytes

A

short chain fatty acids

44
Q

Medication that can help restore intestinal function and structural inegrity through intestinotrophic and proabsorptive effects and indicated in short bowel syndrome

A

teduglutide, a glucagon like peptide 2 analog

45
Q

plain film findings of gallstone ileus:

A

air in biliary tree, calcified gallstone in RLQ, air fluid levels and small bowel distention

46
Q

RCTs have shown that in patients undergoing colorectal surgery, _____ sheets decrease the risk of adhesion formation and reoperations for adhesive SBO.

A

hyaluronic acid sheets (seprafilm)

47
Q

High ileostomy output is defined as:

A

> 1200mL/day

48
Q

_____ is superior to vancomycin in treatment of recurrent C. difficile infections.

A

Fidoxamicin

49
Q

True or false. Staple hemorrhoidectomy is associated with less pain, early return to work, less operative time than open hemorrhoidectomy.

A

true

50
Q

What complications occur more commonly with stapled hemorrhoidectomy compared to open hemorrhoidectomy?

A

higher rates of tenesmus, higher rates of rectal prolapse, more early bleeding complications, pelvic sepsis complications are higher

51
Q

What is SMA syndrome?

A

entrapment of the 3rd portion of the duodenum between the SMA and aorta (decreased angle) caused by loss of intraabdominal fat

52
Q

2 most common antecedent events for SMA syndrome:

A

weight loss and corrective surgery for scoliosis

53
Q

Symptoms of SMA syndrome:

A

weight loss, epigastric postprandial pain and satiety; high volume emesis of partially digested food

54
Q

Findings of SMA syndrome on barium UGI:

A

abrupt cutoff of contrast at 3rd portion of duodenum relieved by proning or moving to right lateral decubitus

55
Q

Treatment of SMA syndrome:

A

duodenojejunostomy

56
Q

Most reliable way to detect C. difficile infection:

A

toxigenic stool culture

57
Q

Rapid test for C. difficile with high negative predictive value:

A

PCR for C diiff

58
Q

test that detects heme from humans and nonhuman sources:

A

fecal occult blood test

59
Q

test that detects heme specifically from human colon:

A

fecal immunohistochemical test (FIT)

60
Q

first step in evaluation of suspected Ogilvie syndrome:

A

rule out distal obstruction by gastrografin enema or CT with rectal contrast

61
Q

Procedure of choice for anal incontinence with an identified/confirmed sphincter defect:

A

overlapping sphincteroplasty

62
Q

True or false. A 4 day course of antibiotics for perforated appendicitis is as efficacious as a longer duration treatment when abscess is present.

A

true

63
Q

What type(s) of medication are protective against radiation enteritis?

A

ACE inhibitors and statins

64
Q

Three approaches to performing a parastomal hernia repair:

A

local repair, repair with prosethetic mesh, stoma relocation

65
Q

True or false. An end ileostomy is more likely to develop a parastomal hernia than a loop ileostomy.

A

False. Loop ileostomy is more likely to develop a hernia because it requires a larger incision

66
Q

Complications of chronic TPN and short bowel syndrome:

A 
metabolic bone disease
PN associated liver disease
cholelithiaiss
nephrolithiasis
catheter related blood stream infections
67
Q

Most common location of iatrogenic perforation from colonoscopy

A

sigmoid

68
Q

What is a ripstein repair for rectal prolapse and what is the most common complication?

A

transabdominal proctopexy (with mesh affixed to presacral fascia); most common complication is constipation

69
Q

Most common cause of lower GI bleeding in the cecum/right colon in the unites for patients over 65

A

angiodysplasia

70
Q

Most common cause of lower GI bleeding in the left colon in patients of any age as well as overall in patients under 65

A

diverticulosis

71
Q

True or false. In patients being considered for appendectomy, enteral contrast improves the accuracy of diagnosis compared with IV contrast alone.

A

false. there is no proven benefit in dx

72
Q

What determines the surgical management for Meckel diverticulum?

A

presence or absence of palpable abnormality, inflammation, or perforation

in presence of inflammation, perforation, and palpable abnormality - perform segmental resection
in absense of these findings - simple diverticulectomy acceptable

73
Q

True or false. Inversion of a Meckels diverticulum leaves the patient with a risk of malignancy

A

true

74
Q

Visualization of what structures indicates adequate medial mobilization for a right hemicolectomy:

A

duodenum and pancreatic head

Small & Large Intestine (5 decks)

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