Small and Large Intestines and Appendix Flashcards
T/F: In a laparoscopic surgery performed for potential appendicitis, the appendix should always be removed, even if it isn’t pathologic.
True. This avoids confusion later on
Which of the following causes inflammation of the whole bowel wall, and which of only the mucosa and submucosa?
UC vs Crohn’s
Crohn’s: full wall inflammation
UC: mucosa and submucosa
After _______ years of colitis surveillance, colonoscopy should be performed with multiple random biopsies.
8-10
What should be done if dysplasia is found in a colon of a person with UC?
Total proctocolectomy
Why should neither barium enema nor colonoscopy be performed if a patient seems to have diverticulitis?
Threat for potential perforation
A massively distended loop in the RUQ with obstructive bowel disease is characteristic of:
sigmoid volvulus
What is the treatment of sigmoid volvulus?
Rigid sigmoidoscopy (if within the 25 cm of the anus) or flexible endoscopy. Laparoscopy if perfed
A bleeding rate of __mL/min is needed for a positive angiography scan.
0.5 mL/min
How is angiodysplasia of the colon with continued bleeding treated?
Selective injection of vasopressin into the bleeding vessel
Adjuvant chemotherapy with _______ in stage III colon cancer has proven successful in improving prognosis.
5-FU
The portion of the bowel that arises from the midgut extends from what to what?
ampulla of vater to the distal transverse colon
What is the ligament of Treitz?
Connects the duodenojejunal flexure to the connective tissue around the SMA and celiac artery
Though any part of the alimentary tract can be affected, Crohn’s disease usually affects what part?
distal ileum
What does the “stacked coins” on abdominal Xray signify?
Scleroderma, sprue, or jejunal obstruction (valvulae conniventes)
If small bowel ischemia is being caused by nonocclusive ischemic disease and the bowel is not gangrenous, how can it be treated?
Fluid resuscitation and intra-arterial superior mesenteric papaverine administration
Bowel obstruction with a featureless pattern on X ray suggests
ileal obstruction
T/F: In a Richter hernia, only a fraction of the bowel wall has become entrapped in the hernia sac and normal bowel movements can still occur.
True
What is the exclusive site of bile acid resorption?
ileum. Its resection can lead to steatorrhea
In which is transit time longer: jejunum or ileum?
Ileum. This is why patients do not fare as well after ileal resection as after jejunal resection, where villi hypertrophies and the ileum can compensate.
Where is vitamin B12 absorbed?
distal ileum
What is the most likely condition to lead ot massive bowel resection?
major ischemia
What type of anemia is seen in blind loop syndrome?
Macrocytic
Bacteria proliferate in a bypassed bowel that does not have peristaltic activity. B12 and folate are malabsobed
Where is iron absorbed?
duodenum
Where is folate absorbed?
proximal jejunum and ileum
Is the small bowel or large bowel more prone to fistulization?
small
T/F: Increased oxygen tension impairs wound healing.
False, it promotes it!
T/F: Use of doxorubicin impairs wound healing.
True
Where is McBurney’s point?
Between the inner 2/3 and outer 1/3 of the line between the umbilicus and ASIS
What is “thumbprinting” of an AXR?
inflammation leading to haustra thickening in exacerbations of UC or Crohn’s
What is Rovsing’s sign?
If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis
What is the psoas sign?
Psoas sign or “Obraztsova’s sign” is right lower-quadrant pain that is produced with either the passive extension of the patient’s right hip (patient lying on left side, with knee in flexion) or by the patient’s active flexion of the right hip while supine
Rectal proctitis is evidenced by the presence of
ulcers
Patients with UC are (more/less) likely to have synchronous lesions in colorectal cancer than the general population.
more
Synchronous lesions refer to malignant lesions diagnosed at the time of surgery or within ___ months after operation.
6
Metachronous lesions are identified subsequently
What is an anterior colonic resection?
Remove the sigmoid and proximal rectum, keep the distal rectum
Why should a colonoscopy be performed before a sigmoid or anterior resection or at least within 2-3 months of it?
To check the colon for synchronous lesions
Carcinoma of the colon is more likely to obstruct if found where?
descending colon
What is the treatment of a large tear in the sigmoid colon with extensive devitalization and contamination in the presence of a foreign body?
Sigmoidoscopy, laparotomy, closure of sigmoid tear, and proximal colostomy or extravasation of fistula. If tear is very large, resection may be needed.
T/F: Sigmoidoscopy and barium studies may help differentiate sigmoid volvulus from colorectal CA.
True
What is the test to rule out sigmoid ischemia?
Sigmoidoscopy
Hypotensive patient bleeding per rectum with no response to IV fluids. Treatment?
Laparosocpy and subtotal colectomy (no time to localize bleeding)
Vomiting that occurs earlier in the presentation of SBO is more associated with (proximal/distal) obstruction.
proximal. Distal obstruction is likely to present with more distention of the abdomen
T/F: MMC (migrating motor complexes) increase after eating.
False! They are delayed for 3-4 hours after eating.
Which are predominant in the small and large intestine: peristaltic forces or segmentating forces?
segmentation
What is the difference between peristalsis and segmentation?
Perstalsis: rhythmic contractions of the longitudinal muscles of the bowel that move food caudally. Predominant in esophagus.
Segmentation: contractions of circular muscles that can move chyme both directions; predominant in intestines
What are intestinal manifestations of typhoid fever?
Ulceration of Peyer’s patches with perforation in the second to third week, possibly
Mesenteric lymphadenopathy, splenomegaly
Which is the primary site of nutrient absorption? What can’t it absorb?
jejunum
Does not absorb bile salts or B12
T/F; If ileum is transposed before jejunum, it will hypertrophy and become the primary site of nutrient absorption.
True
Where is Meissner’s plexus located? Myenteric/Auerbach’s plexus?
Meissner's = submucosa, PNS only. Configuration of luminal surface, secretions, transport Myenteric = between longitudinal and circular muscles, PNS and SNS. Peristlasis. Pathologic in Hirschsprung and achalasia
What is a sliding inguinal hernia?
Sliding hernias are those in which part of the wall of the sac is formed by a viscus
T/F: A patient with a perianal abscess is unlikely to have fever or leukocytosis.
True
Deep rectal pain, fever, leukocytosis following pelvic surgery:
supralevator abscess
Which sinus opens into the anal mucosa on the midline?
posterior perianal sinus (external opening in posterior half of skin surrounding anus)
What is the most common site for a pilonidal cyst to develop?
Posterior midline in natal (intergluteal) cleft
