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Chapter 29. Small Bowel

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The most common cause of small bowel obstruction is

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A. Intra-abdominal adhesions

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B. Neoplasms

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C. Intussusception

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D. Crohn’s disease

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A. Intra-abdominal adhesions. Sixty percent to 75% of cases of mechanical SBO are secondary to adhesions, related to prior abdominal surgery. Lower abdominal and pelvic surgery appears to be associated with a higher incidence of adhesions than the upper abdominal surgery. Congenital bands are rarely seen in children.

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The treatment of small bowel obstruction includes

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A. Nasogastric suction

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B. Fluid and electrolyte resuscitation

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C. Laparoscopic adhesiolysis in highly selected case

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D. All of the above

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D. All of the above. A nasogastric tube should be inserted early in order to relieve symptoms, avoid aspiration, and monitor the fluid and electrolyte losses. Depending on the level and duration of obstruction, fluid and electrolyte deficit vary. The exact volume of fluid and electrolytes must be calculated individually for each patient. In some cases, in which there is preoperative evidence of free space in the abdomen for the trocar placement, laparoscopy finds a good indication. Laparoscopic adhesiolysis reduces the risk of further adhesions thanks to the reduced peritoneal trauma.

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One of the following sentences about acute mesenteric ischemia is wrong:

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A. The most common cause is the arterial embolism.

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B. Thrombosis of mesenteric veins is often associated with portal hypertension.

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C. Deep venous thrombosis can be a cause.

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D. Abdominal pain is the main clinical finding.

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C. Deep venous thrombosis can be a cause. Acute mesenteric ischemia is characterized by severe and diffuse abdominal pain that is often unresponsive to narcotics. Mesenteric arterial embolism accounts for about 50% of cases. The main cause is atrial fibrillation. Venous thrombosis can be a consequence of venous stasis (as in portal hypertension) or hypercoagulability (congenital disorders, oral contraceptives).

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Deep venous thrombosis may cause pulmonary embolism but not mesenteric thrombosis.

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Which sentence about small bowel tumors is correct?

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A. Adenomas are more common in the distal ileum.

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B. The most common neoplasm is GIST.

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C. Peutz–Jeghers syndrome has a very high malignant potential.

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