Bowel Path I

Question 1

small intestine

Answer 1

duodenum
jejunum
ileum

digest/absorb protein, carb, lipid

absorb vits, minerals

protects against intruders

resorption of water

Question 2

hepatic flexure

Answer 2

large bowel - right side

Question 3

splenic flexure

Answer 3

large bowel - left side

Question 4

paralytic lieus

Answer 4

intestine has no contractions - functional obstruction

Question 5

big 4 causes GI obstruction

Answer 5

adhesions
hernia
volvulus
intussusception

Question 6

pseudo obstruction

Answer 6

paralytic ileus - post op

Question 7

GI obstruction sx

Answer 7

pain
distension
vomiting
constipation

usually requiring surgery
-not paralytic ileus

Question 8

small bowel obstruction

Answer 8

pain is colicky - cramping and intermittent

Question 9

large bowel obstruction

Answer 9

longer lasting spasms

constipation early and vomiting less prominent

Question 10

CT of obstruction

Answer 10

full of fluid and see air level

Question 11

intussusception

Answer 11

part of intestine invaginated into another section

telescoping

most frequent - ileum entering cecum

Question 12

dances sign

Answer 12

intussusception

Question 13

diagnosis of intussusception

Answer 13

ultrasound

target like mass - 3cm in diameter

Question 14

target mass

Answer 14

ultrasound with intussusception

Question 15

tx of intussusception

Answer 15

barium enema - confirms dx and reduces it

surgical reduction if this doesnt work

Question 16

red currant jelly

Answer 16

with intussusception

-ischemic mucosa is sloughed off

Question 17

inguinal hernia

Answer 17

majority right sided
-males

cannot be reduced = incarceration

Question 18

direct inguinal hernia

Answer 18

medial to inferior epigastric vessels - transversalis fascia

indirect inguinal hernia - deep inguinal ring - lateral to inferior epigastric vessels - fail of closure of processus vaginalis

Question 19

most common cause of intestinal obstruction worldwide

Answer 19

hernia

in US - adhesions

Question 20

volvulus

Answer 20

malrotation of loop of blwel

infants or adults

commonly in the sigmoid colon

Question 21

diagnosis of volvulus

Answer 21

abdominal x-ray

Question 22

coffee bean sign

Answer 22

x-ray of volvulus

or bent-inner tube

Question 23

birds beak

Answer 23

diagnosis of volvulus using barium enema

Question 24

adhesions

Answer 24

fibrous bands between tissues and organs
-internal scar tissue after surgery-injury

-most common cuase of obstruction in US

can lead to internal hernia

complete obstruction - surgical intervention

most improve conservative care within 2-5 days

Question 25

ischemic bowel disease etiology

Answer 25

often arterial embolism or thrombosis - second most common - superior mesenteric artery

Question 26

cocaine

Answer 26

non-occlusive IBD

Question 27

transmural bowel infarct

Answer 27

bad - contents can leak out with perforation in 1-4 days

Question 28

rapid onset of periumbilical pain with nausea and vomiting

Answer 28

intestinal infarct

Question 29

mesenteric ischemia

Answer 29

inflammation and injury of small intestine result from inadequate blood supply common in elderly three phases: 1 hyperactive - abdominal pain and bloody stool 2 paralytic - loss motility 3 shock - fluid leak through colon lining

Question 30

superior mesenteric artery

Answer 30

ascending and transverse colon

Question 31

inferior mesenteric artery

Answer 31

descending colon, sigmoid, rectum

Question 32

watershed areas

Answer 32

weak points in blood flow to colon -between SMA and IMA boundaries splenic flexure and transverse colon vulnerable to ischemia

Question 33

rectum

Answer 33

dual blood supply

Question 34

ischemic colititis diagnosis

Answer 34

scope

Question 35

tx ischemic colitis

Answer 35

supportive surgery if severe

Question 36

angiodysplasia

Answer 36

non-neoplastic vascular lesion cecum or prox right colon path unknown tortuous dilatation of malformed submucosa and mucosa blood vessels 60yo significant bleeding can occur resembles telangiectasia

Question 37

heydes syndrome

Answer 37

angiodysplasia with aortic valve stenosis vWF - protelysed with high shear stress

Question 38

hemorrhoids

Answer 38

pregnancy cirrosis most commonly - straining of stool**

Question 39

internal hemorrhoids

Answer 39

painless bleeding

Question 40

external hemorrhoids

Answer 40

painful

Question 41

secretory diarrhea

Answer 41

>500mL isotonic fluid stool daily persist during fasting** infectious

Question 42

osmotic diarrhea

Answer 42

>500mL hypertonic fluid abates with fasting** lactase deficiency

Question 43

exudative diarrhea

Answer 43

mucosal damage -purulent bloody stools - persists during fasting - bacterial or IBD

Question 44

deranged motility diarrhea

Answer 44

improper neuromuscular variable during fasting**

Question 45

malabsorption diarrhea

Answer 45

improper absorption -bulky stool - excess fat abates with fasting** celiac, giardia, pancreatitis, CF

Question 46

diarrhea

Answer 46

increase in stool mass, frequency or fluiditiy

Question 47

dysentery

Answer 47

low volume bloody diarrhea

Question 48

standard test for malabsorption

Answer 48

72 hour stool for fat pt diet 100g fat day more than 18-20g fat in stool - pt has malabsorption

Question 49

malabsorption

Answer 49

luminal phase - pancreatitis, CF mucosal phase - celiac sprue postabsorptive phase - lymph obstruction

Question 50

infectious enterocolitis

Answer 50

huge worldwide problem viral - rotavirus bacterial - 3 mechanisms also parasitic responsible for lots of death worldwide