35 Small Bowel ANATOMY AND PHYSIOLOGY

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Questions and Answers

What is the primary nutrient for the small bowel?

  • Fructose
  • Sucrose
  • Glutamine (correct)
  • Glucose

In which portion of the small intestine is 90% of ulcers located?

  • Transverse (3rd portion)
  • Descending (2nd portion)
  • Bulb (1st portion) (correct)
  • Ascending (4th portion)

Where does the maximum absorption of B12 occur in the small intestine?

  • Descending portion
  • Jejunum
  • Ileum (correct)
  • Duodenum

Which artery eventually branches into the ileocolic artery?

<p>Superior mesenteric artery (C)</p> Signup and view all the answers

What is the length of the jejunum in centimeters?

<p>100 cm (B)</p> Signup and view all the answers

Where do the descending and transverse portions of the small intestine lie?

<p>Retroperitoneally (A)</p> Signup and view all the answers

What is the most common cause of death in patients with pseudomyxoma peritonei?

<p>Small bowel obstruction (C)</p> Signup and view all the answers

In the context of presumed appendicitis, what condition would still warrant an appendectomy to prevent future confounding diagnosis?

<p>Regional enteritis not involving the cecum (D)</p> Signup and view all the answers

What distinguishes ileus from obstruction?

<p>Presence of bowel decompression distal to the obstruction (D)</p> Signup and view all the answers

What is the recommended treatment for typhoid enteritis caused by Salmonella in children?

<p>Bactrim (B)</p> Signup and view all the answers

What is the characteristic rash associated with typhoid enteritis in children?

<p>Maculopapular rash (D)</p> Signup and view all the answers

What is the potential consequence of a mucocele if it is malignant?

<p>Pseudomyxoma peritonei (C)</p> Signup and view all the answers

Which cell type releases 5-hydroxytryptamine and acts as a carcinoid precursor?

<p>Enterochromaffin cells (B)</p> Signup and view all the answers

What is the most important hormone in the migrating motor complex?

<p>Motilin (A)</p> Signup and view all the answers

Which gland produces an alkaline solution?

<p>Brunner’s glands (C)</p> Signup and view all the answers

What is the primary cause of gallstones after terminal ileum resection?

<p>Malabsorption of bile salts (C)</p> Signup and view all the answers

Which test checks for B12 absorption?

<p>Schilling test (A)</p> Signup and view all the answers

What is the mnemonic for nonhealing fistula causes?

<p>FRIENDSS (A)</p> Signup and view all the answers

What is the most common cause of small bowel obstruction in patients with previous surgery?

<p>Adhesions (D)</p> Signup and view all the answers

Which symptom is typically associated with proximal small bowel (open loop) obstruction?

<p>Continuous vomiting of large volumes (D)</p> Signup and view all the answers

What is the classic location for gallstone ileus?

<p>Ileum (C)</p> Signup and view all the answers

What is the primary cause of high-output fistulas?

<p>Proximal bowel (duodenum or proximal jejunum) (D)</p> Signup and view all the answers

What is the primary surgical indication for small bowel obstruction?

<p>+Progressing pain and peritoneal signs (D)</p> Signup and view all the answers

What is the primary infectious cause to check for in patients with persistent fever or sepsis due to nonhealing fistulas?

<p>Abscess (A)</p> Signup and view all the answers

What is the most common type of tissue found in Meckel's diverticulum that can cause diverticulitis?

<p>Gastric mucosa (A)</p> Signup and view all the answers

What is the most common presentation of Meckel's diverticulum in adults?

<p>Obstruction (A)</p> Signup and view all the answers

Which type of diverticulum is caused by the failure of closure of the omphalomesenteric duct?

<p>Meckel's diverticulum (D)</p> Signup and view all the answers

What is the recommended treatment for uncomplicated diverticulitis or bleeding in Meckel's diverticulum?

<p>Diverticulectomy (C)</p> Signup and view all the answers

In which population is there an increased incidence of Crohn's disease?

<p>Ashkenazi Jewish population (A)</p> Signup and view all the answers

What is the most common extra-intestinal manifestation of Crohn's disease?

<p>Arthritis (C)</p> Signup and view all the answers

What is the medical treatment option for acute flares of Crohn's disease if infection or toxic megacolon/colitis is a concern?

<p>Cipro and Flagyl (A)</p> Signup and view all the answers

What is the surgical procedure of choice for diffuse severe disease of the colon in Crohn's disease?

<p>Proctocolectomy and ileostomy (B)</p> Signup and view all the answers

What is the incidence of recurrence requiring surgery for Crohn’s disease after resection?

<p>50% (A)</p> Signup and view all the answers

What is the most common type of tissue found in Meckel's diverticulum that can cause obstructive symptoms?

<p>Pancreas tissue (D)</p> Signup and view all the answers

What is the most common presentation of Meckel's diverticulum in children under 2 years old?

<p>Painless lower GI bleeding (D)</p> Signup and view all the answers

Which of the following is the most common site for carcinoid tumor?

<p>Appendix (A)</p> Signup and view all the answers

What is the recommended treatment for a carcinoid in the appendix that is less than 2 cm?

<p>Appendectomy (C)</p> Signup and view all the answers

Which syndrome is associated with small bowel carcinoid and indicates an increased risk for multiple primaries and second unrelated malignancies?

<p>Peutz–Jeghers syndrome (B)</p> Signup and view all the answers

What is the highest sensitivity test for detecting a carcinoid tumor?

<p>Chromogranin A level (D)</p> Signup and view all the answers

Which type of tumor is most common in the duodenum and may present with symptoms of obstruction and jaundice?

<p>Adenocarcinoma (A)</p> Signup and view all the answers

Which condition is the most common cause of intussusception in adults and can lead to obstruction?

<p>Cecal cancer (C)</p> Signup and view all the answers

What is the most common presentation of appendicitis in adults?

<p>Anorexia followed by abdominal pain (periumbilical) (B)</p> Signup and view all the answers

What is the most common cause of appendicitis in children?

<p>Lymphoid hyperplasia (A)</p> Signup and view all the answers

What is the primary cause of stenosis of a stoma?

<p>Ischemia (B)</p> Signup and view all the answers

Which condition would still warrant an appendectomy to prevent future confounding diagnosis despite a walled-off perforated appendix seen on CT scan?

<p>Mucocele (C)</p> Signup and view all the answers

Which test would be necessary for women with suspected appendicitis to rule out OB/GYN causes of abdominal pain?

<p>Beta-HCG test (C)</p> Signup and view all the answers

What is the primary cause of high-output fistulas near a stoma site?

<p>Crohn’s disease (A)</p> Signup and view all the answers

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