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SURGERY_LANGE > Small and Large Intestines and Appendix > Flashcards

Small and Large Intestines and Appendix Flashcards

1
Q

T/F: In a laparoscopic surgery performed for potential appendicitis, the appendix should always be removed, even if it isn’t pathologic.

A

True. This avoids confusion later on

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2
Q

Which of the following causes inflammation of the whole bowel wall, and which of only the mucosa and submucosa?

UC vs Crohn’s

A

Crohn’s: full wall inflammation

UC: mucosa and submucosa

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3
Q

After _______ years of colitis surveillance, colonoscopy should be performed with multiple random biopsies.

A

8-10

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4
Q

What should be done if dysplasia is found in a colon of a person with UC?

A

Total proctocolectomy

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5
Q

Why should neither barium enema nor colonoscopy be performed if a patient seems to have diverticulitis?

A

Threat for potential perforation

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6
Q

A massively distended loop in the RUQ with obstructive bowel disease is characteristic of:

A

sigmoid volvulus

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7
Q

What is the treatment of sigmoid volvulus?

A

Rigid sigmoidoscopy (if within the 25 cm of the anus) or flexible endoscopy. Laparoscopy if perfed

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8
Q

A bleeding rate of __mL/min is needed for a positive angiography scan.

A

0.5 mL/min

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9
Q

How is angiodysplasia of the colon with continued bleeding treated?

A

Selective injection of vasopressin into the bleeding vessel

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10
Q

Adjuvant chemotherapy with _______ in stage III colon cancer has proven successful in improving prognosis.

A

5-FU

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11
Q

The portion of the bowel that arises from the midgut extends from what to what?

A

ampulla of vater to the distal transverse colon

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12
Q

What is the ligament of Treitz?

A

Connects the duodenojejunal flexure to the connective tissue around the SMA and celiac artery

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13
Q

Though any part of the alimentary tract can be affected, Crohn’s disease usually affects what part?

A

distal ileum

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14
Q

What does the “stacked coins” on abdominal Xray signify?

A

Scleroderma, sprue, or jejunal obstruction (valvulae conniventes)

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15
Q

If small bowel ischemia is being caused by nonocclusive ischemic disease and the bowel is not gangrenous, how can it be treated?

A

Fluid resuscitation and intra-arterial superior mesenteric papaverine administration

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16
Q

Bowel obstruction with a featureless pattern on X ray suggests

A

ileal obstruction

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17
Q

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.

A

True

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18
Q

What is the exclusive site of bile acid resorption?

A

ileum. Its resection can lead to steatorrhea

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19
Q

In which is transit time longer: jejunum or ileum?

A

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.

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20
Q

Where is vitamin B12 absorbed?

A

distal ileum

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21
Q

What is the most likely condition to lead ot massive bowel resection?

A

major ischemia

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22
Q

What type of anemia is seen in blind loop syndrome?

A

Macrocytic

Bacteria proliferate in a bypassed bowel that does not have peristaltic activity. B12 and folate are malabsobed

23
Q

Where is iron absorbed?

A

duodenum

24
Q

Where is folate absorbed?

A

proximal jejunum and ileum

25
Q

Is the small bowel or large bowel more prone to fistulization?

A

small

26
Q

T/F: Increased oxygen tension impairs wound healing.

A

False, it promotes it!

27
Q

T/F: Use of doxorubicin impairs wound healing.

A

True

28
Q

Where is McBurney’s point?

A

Between the inner 2/3 and outer 1/3 of the line between the umbilicus and ASIS

29
Q

What is “thumbprinting” of an AXR?

A

inflammation leading to haustra thickening in exacerbations of UC or Crohn’s

30
Q

What is Rovsing’s sign?

A

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

31
Q

What is the psoas sign?

A

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

32
Q

Rectal proctitis is evidenced by the presence of

A

ulcers

33
Q

Patients with UC are (more/less) likely to have synchronous lesions in colorectal cancer than the general population.

A

more

34
Q

Synchronous lesions refer to malignant lesions diagnosed at the time of surgery or within ___ months after operation.

A

6

Metachronous lesions are identified subsequently

35
Q

What is an anterior colonic resection?

A

Remove the sigmoid and proximal rectum, keep the distal rectum

36
Q

Why should a colonoscopy be performed before a sigmoid or anterior resection or at least within 2-3 months of it?

A

To check the colon for synchronous lesions

37
Q

Carcinoma of the colon is more likely to obstruct if found where?

A

descending colon

38
Q

What is the treatment of a large tear in the sigmoid colon with extensive devitalization and contamination in the presence of a foreign body?

A

Sigmoidoscopy, laparotomy, closure of sigmoid tear, and proximal colostomy or extravasation of fistula. If tear is very large, resection may be needed.

39
Q

T/F: Sigmoidoscopy and barium studies may help differentiate sigmoid volvulus from colorectal CA.

A

True

40
Q

What is the test to rule out sigmoid ischemia?

A

Sigmoidoscopy

41
Q

Hypotensive patient bleeding per rectum with no response to IV fluids. Treatment?

A

Laparosocpy and subtotal colectomy (no time to localize bleeding)

42
Q

Vomiting that occurs earlier in the presentation of SBO is more associated with (proximal/distal) obstruction.

A

proximal. Distal obstruction is likely to present with more distention of the abdomen

43
Q

T/F: MMC (migrating motor complexes) increase after eating.

A

False! They are delayed for 3-4 hours after eating.

44
Q

Which are predominant in the small and large intestine: peristaltic forces or segmentating forces?

A

segmentation

45
Q

What is the difference between peristalsis and segmentation?

A

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

46
Q

What are intestinal manifestations of typhoid fever?

A

Ulceration of Peyer’s patches with perforation in the second to third week, possibly
Mesenteric lymphadenopathy, splenomegaly

47
Q

Which is the primary site of nutrient absorption? What can’t it absorb?

A

jejunum

Does not absorb bile salts or B12

48
Q

T/F; If ileum is transposed before jejunum, it will hypertrophy and become the primary site of nutrient absorption.

A

True

49
Q

Where is Meissner’s plexus located? Myenteric/Auerbach’s plexus?

A 
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
50
Q

What is a sliding inguinal hernia?

A

Sliding hernias are those in which part of the wall of the sac is formed by a viscus

51
Q

T/F: A patient with a perianal abscess is unlikely to have fever or leukocytosis.

A

True

52
Q

Deep rectal pain, fever, leukocytosis following pelvic surgery:

A

supralevator abscess

53
Q

Which sinus opens into the anal mucosa on the midline?

A

posterior perianal sinus (external opening in posterior half of skin surrounding anus)

54
Q

What is the most common site for a pilonidal cyst to develop?

A

Posterior midline in natal (intergluteal) cleft

SURGERY_LANGE (14 decks)

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