Potpourri

Question 1

Disorder characterized by bacterial overgrowth of a segment of small intestine from a segment that is bypassed leading to diarrhea, steatorrhea, malnutrition, megaloblastic anemia (B12 deficiency)

Answer 1

blind loop syndrome

Question 2

Diagnostic test for blind loop syndrome:

Answer 2

d-xylose test

Question 3

Appearance of cystic pneumatosis intestinalis:

Answer 3

granular or foamy appearance that represents gas in the submucosa

Question 4

Appearance of linear pneumatosis intestinalis:

Answer 4

consists of small bubbles within the muscular mucosa and subserosa to form a thin linear or curvilinear gas pattern outlining the wall of a segment of intestine

Question 5

gold standard imaging modality to diagnosis intussusception

Answer 5

CT scan

Question 6

Radiologic features of toxic megacolon:

Answer 6

cecal diameter >12cm or colonic dilation >6cm

Question 7

Treatment of toxic megacolon:

Answer 7

total abdominal colectomy with end ileostomy

Question 8

Output of a low output fistula:

Answer 8

<200cc/D

Question 9

Output of intermediate output fistula:

Answer 9

200-500cc/D

Question 10

Output of a high output fistula:

Answer 10

> 500cc/D

Question 11

True or false. 4 day fixed course of IV abx isi as efficacious as longer duration treatment for intraabdominal abscess.

Answer 11

true

Question 12

Medication that enhances GI recovery after colon surgery by antagonizing the peripheral effects of opioids on GI motility

Answer 12

alvimopan (Entereg)

Question 13

when is operative management for a fistula indicated:

Answer 13

after failure of nonoperative management after a 6-8 week period

Question 14

Risk factors for development of symptoms from a Meckel’s diverticulum:

Answer 14

male sex, age younger than 50, diverticulum length >2cm; presence of ectopic gastric tissue (strongest risk factor)

Question 15

Complications of TPN and short gut syndrome:

Answer 15

metabolic bone disease, cholelithiasis, nephrolithiasis, liver disease, blood stream infections

yearly DEXA and routine LFTs indicated

Question 16

99m technetium pertechnate scan for Meckels has an affinity for identification of____

Answer 16

gastric mucosa

Question 17

antibiotic of choice for small bowel intestinal overgrowth

Answer 17

rifaximin

Question 18

treatment of first uncomplicated episode of C. difficile:

Answer 18

oral metronidazole

Question 19

treatment of recurrent C. difficile after receiving metronidazole:

Answer 19

oral vancomycin for 10 days

Question 20

treatment of recurrent C. difficile after initial treatment with vancomycin:

Answer 20

pulse tapered oral vancomycin or oral fidaxomicin

Question 21

treatment of multiple refractory C difficile episodes

Answer 21

fecal transplant

Question 22

Treatment of Olgivies:

Answer 22

medical management initially and rule out mechanical obstruction
if unsuccessful, then neostigmine
if neostigmine unsuccessful, then colonic decompression

Question 23

True or false. Incidentally discovered Meckels does not indicate need for resection.

Answer 23

true

Question 24

True or false. Stomal necrosis that does not extend beyond/below the fascia still requires emergent intervention.

Answer 24

false

Question 25

Most common complication of ileostomy reversal

Answer 25

SBO

Question 26

Where is cholecystokinin produced?

Answer 26

I cells of duodenum and jejunum

Question 27

What stimulates release of cholecystokinin?

Answer 27

fat, protein, and amino acid ingestion

Question 28

What effects does cholecystokinin have?

Answer 28

increases antral and pyloric contraction, relaxes sphincter of Oddi, stimulates GB contraction, stimulates secretion of pancreatic enzymes

Question 29

Condition associated with immunosuppression that is characterized by numerous polyps in the small and large intestine that consist of enlarged submucosal lymphoid follicles:

Answer 29

nodular lymphoid hyperplasia

Question 30

Physiologic effects of using vasopressin to control GI bleed:

Answer 30

initiates arteriolar vasoconstriction and bowel wall contraction; side effects are MI, HTN, dysrhythmias, mesenteric thrombosis, simultaneous IV nitroglycerin is paramount to counteracting side effects

Question 31

For GI bleeds,_____ has largely replaced vasopressin infusion due to its complications and rebleeding rate.

Answer 31

transcatheter embolization

Question 32

Best test to confirm ischemic colitis:

Answer 32

endoscopy

Question 33

Injury of less than ___ of the circumference of the large intestine can be repaired primarily.

Answer 33

50%

Question 34

Preoperative albumin of less than ____ is a risk factor for anastomotic leak after colorectal surgery

Answer 34

<3.5g/dL

Question 35

True or false. COPD can cause pneumatosis intestinalis.

Answer 35

true

Question 36

Medications that can cause paralytic ileus:

Answer 36

opiates, antihistamines, alpha adrenergic agonists, anticholinergics

Question 37

____ is the most common complication of stricturoplasty.

Answer 37

Hemorrhage

Question 38

What is the colonoscopy screening regimen for a patient who has a 1st degree relative with an advanced adenoma, adenoma >1cm, or an adenoma with a villous component?

Answer 38

colonoscopy starting at age 40 or age of adenoma onset, whichever is first and then every 5-10 years if normal

Question 39

screning regiment for average risk patient of colon cancer:

Answer 39

colonoscopy at age 50 and every 10 years after that if normal

Question 40

True or false. External anal sphincter is under involuntary control

Answer 40

false

Question 41

Where does the external anal sphincter receive innervation from ?

Answer 41

inferior rectal branches of the pudendal nerve and the perineal branches of the fourth sacral nerve (S4)

Question 42

Primary fuel source of small bowel enterocytes

Answer 42

glutamine

Question 43

Primary fuel source for colonocytes

Answer 43

short chain fatty acids

Question 44

Medication that can help restore intestinal function and structural inegrity through intestinotrophic and proabsorptive effects and indicated in short bowel syndrome

Answer 44

teduglutide, a glucagon like peptide 2 analog

Question 45

plain film findings of gallstone ileus:

Answer 45

air in biliary tree, calcified gallstone in RLQ, air fluid levels and small bowel distention

Question 46

RCTs have shown that in patients undergoing colorectal surgery, _____ sheets decrease the risk of adhesion formation and reoperations for adhesive SBO.

Answer 46

hyaluronic acid sheets (seprafilm)

Question 47

High ileostomy output is defined as:

Answer 47

>1200mL/day

Question 48

_____ is superior to vancomycin in treatment of recurrent C. difficile infections.

Answer 48

Fidoxamicin

Question 49

True or false. Staple hemorrhoidectomy is associated with less pain, early return to work, less operative time than open hemorrhoidectomy.

Answer 49

true

Question 50

What complications occur more commonly with stapled hemorrhoidectomy compared to open hemorrhoidectomy?

Answer 50

higher rates of tenesmus, higher rates of rectal prolapse, more early bleeding complications, pelvic sepsis complications are higher

Question 51

What is SMA syndrome?

Answer 51

entrapment of the 3rd portion of the duodenum between the SMA and aorta (decreased angle) caused by loss of intraabdominal fat

Question 52

2 most common antecedent events for SMA syndrome:

Answer 52

weight loss and corrective surgery for scoliosis

Question 53

Symptoms of SMA syndrome:

Answer 53

weight loss, epigastric postprandial pain and satiety; high volume emesis of partially digested food

Question 54

Findings of SMA syndrome on barium UGI:

Answer 54

abrupt cutoff of contrast at 3rd portion of duodenum relieved by proning or moving to right lateral decubitus

Question 55

Treatment of SMA syndrome:

Answer 55

duodenojejunostomy

Question 56

Most reliable way to detect C. difficile infection:

Answer 56

toxigenic stool culture

Question 57

Rapid test for C. difficile with high negative predictive value:

Answer 57

PCR for C diiff

Question 58

test that detects heme from humans and nonhuman sources:

Answer 58

fecal occult blood test

Question 59

test that detects heme specifically from human colon:

Answer 59

fecal immunohistochemical test (FIT)

Question 60

first step in evaluation of suspected Ogilvie syndrome:

Answer 60

rule out distal obstruction by gastrografin enema or CT with rectal contrast

Question 61

Procedure of choice for anal incontinence with an identified/confirmed sphincter defect:

Answer 61

overlapping sphincteroplasty

Question 62

True or false. A 4 day course of antibiotics for perforated appendicitis is as efficacious as a longer duration treatment when abscess is present.

Answer 62

true

Question 63

What type(s) of medication are protective against radiation enteritis?

Answer 63

ACE inhibitors and statins

Question 64

Three approaches to performing a parastomal hernia repair:

Answer 64

local repair, repair with prosethetic mesh, stoma relocation

Question 65

True or false. An end ileostomy is more likely to develop a parastomal hernia than a loop ileostomy.

Answer 65

False. Loop ileostomy is more likely to develop a hernia because it requires a larger incision

Question 66

Complications of chronic TPN and short bowel syndrome:

Answer 66

``` metabolic bone disease PN associated liver disease cholelithiaiss nephrolithiasis catheter related blood stream infections ```

Question 67

Most common location of iatrogenic perforation from colonoscopy

Answer 67

sigmoid

Question 68

What is a ripstein repair for rectal prolapse and what is the most common complication?

Answer 68

transabdominal proctopexy (with mesh affixed to presacral fascia); most common complication is constipation

Question 69

Most common cause of lower GI bleeding in the cecum/right colon in the unites for patients over 65

Answer 69

angiodysplasia

Question 70

Most common cause of lower GI bleeding in the left colon in patients of any age as well as overall in patients under 65

Answer 70

diverticulosis

Question 71

True or false. In patients being considered for appendectomy, enteral contrast improves the accuracy of diagnosis compared with IV contrast alone.

Answer 71

false. there is no proven benefit in dx

Question 72

What determines the surgical management for Meckel diverticulum?

Answer 72

presence or absence of palpable abnormality, inflammation, or perforation in presence of inflammation, perforation, and palpable abnormality - perform segmental resection in absense of these findings - simple diverticulectomy acceptable

Question 73

True or false. Inversion of a Meckels diverticulum leaves the patient with a risk of malignancy

Answer 73

true

Question 74

Visualization of what structures indicates adequate medial mobilization for a right hemicolectomy:

Answer 74

duodenum and pancreatic head