A 48 yo man is seen in clinic b/c of wt loss and diarrhea. He has a history of alcoholism and chronic pancreatitis. He has been abstinent from alcohol for the past two years. His only medication is pancreatic enzyme replacement. He has a number of questions about his sxs and the absorptive functions of the small intestine. Which of the following best characterizes small intestinal absorptive function?
Is closely linked to Na-coupled nutrient absorption
An 8 yo boy is brought to the ED by his parents b/c of acute abd pain and vomiting. He had been feeling well until the pain developed suddenly several hours before presentation. The parents mention that a CT scan done a year ago following a fall off a bicycle showed malrotation of the intestine. What is the most likely cause of the pt’s symptoms?
A 24 yo woman is in clinic in follow-up b/c of small bowel motility dysfunction. She has read a lot of info on the internet and has a number of questions regarding the normal physiology of the small intestine. As part of this discussion, you explain the migrating motor complex (MMC). Which of the following best characterizes the MMC?
Helps to prevent stasis and bacterial overgrowth
A 23 yo man is seen in clinic in f/u of known ileocolic Crohn’s disease. He is concerned with the potential metabolic side effects of his disease. Which one of the following metabolic side effects is he at most risk for developing?
Vitamin B12 deficiency
A 19 yo woman is seen in clinic for counseling after recently being diagnosed with ileocolic Crohn’s disease. She asks about the possibility of developing fistulous disease in the future, and whether this would require surgical intervention if it occurred. Which of the following fistulous complications of Crohn’s disease most commonly requires surgical therapy?
A 24 yo man is seen in clinic following total proctocolectomy and ileoanal pouch anastomosis for familial polyposis. Several of his family members are with him and ask if other sites are prone to malignancy besides the colon in family members affected with the disease. The most common site for an affected relative to develop an extra-colonic malignancy is which of the following?
A 48 yo man is brought to the ED by his wife with a 48hr hx of abd, pain, obstipation, N/V. Initially he had crampy pain, but for the past 4hrs it has been steady. He was previously healthy and there is no hx of previous surgery. He does not smoke or drink alcohol. His BMI is 24. Vital signs are: pulse 120b/min; BP 100/70mmHg; R 26/min. His temp is 37 degrees C. His heart is regular with no murmurs and his lungs are clear. His abdomen is distended and diffusely tender to palpation. Bowel sounds are absent. Abdominal films show dilated air-filled loops of small intestine and minimal colonic gas. IVFs are started and a NG tube is inserted with immediate removal of 1200 mL of thick greenish-brown fluid. What is the next best step in management?
Schedule an emergent laparotomy
A 35 yo woman comes to clinic b/c of diarrhea after meals and progressive wt loss for the past 6mo. She has Crohn’s disease and has undergone multiple abd operations for Crohn’s disease and episodes of adhesive SBO. Six mo ago she underwent a small bowel resection for recurrent Crohn’s disease at a site of a previous small bowel anastomosis. Updated endoscopic and contrast evaluations show no evidence of active recurrent Crohn’s disease. Which of the following postsurgical scenarios might be most consistent with short bowel syndrome as an etiology for the pt’s symptoms?
Less than 60cm small intestine preserved
A 25yo man is being evaluated because of maroon stoll per rectum. He has otherwise been healthy. Colonoscopy is normal and capsule endocscopy suggests that bleeding is coming from the distal small intestine. The presence of a Meckel’s diverticulum as a potential etiology for the bleeding may be able to be identified by which of the following tests?
Technetium pertechnetate scan
A 43 yo woman is seen in the office to discuss surgical plans for removing a small intestinal tumor. She has had several bouts of otherwise unexplained abdominal pain and bloating for the past 6mo. There is evidence of small bowel tumor on capsule endoscopy. You are discussing the embryologic origins of intestinal tumors with her. You strongly suspect that her tumor has arisen from cells that are part of the APUD (amine precursor uptake decarboxylase) system. Which of the following lesions is your most likely diagnosis?