Stricturoplasty is indicated in a Crohn patient with:
A. Fistula at the level of the stricture
B. Intra-abdominal abscess
C. Multiple areas of stenosis
D. Multiple intestinal fistulas
Indications for stricturoplasty include the maintenance of intestinal length after previous resection or the identification of single/multiple strictures in diffusely involved bowel.
Contraindications include the presence of intestinal fistulas or intra-abdominal abscess.
A Heineke-Mikulicz stricturoplasty can be performed for strictures <12 cm in length, a Finney stricturoplasty can be performed for strictures up to 25 cm in length, and a side-to-side isoperistaltic enteroenterostomy can be used for strictures up to 50 cm in length.
How do adults with Meckel diverticulum usually present?
The most common presentation of Meckel diverticula in adults is intestinal obstruction. Obstruction from a Meckel diverticulum occurs in various ways such as intussusception with the diverticulum as the lead point, stricture from chronic diverticulitis, intestinal entrapment by a mesodiverticular band, and volvulus of the intestine around a fibrous band connecting the diverticulum to the umbilicus.
The most common presentation of a Meckel diverticulum in children is bleeding.
Which of the following forms of calcium supplementation should be administered to gastric bypass patients?
Calcium citrate is the supplementation of choice for patients with low acid exposure.
Which of the following is the FIRST to recover from postoperative ileus?
D. The stomach, small intestine, and colon recover from ileus simultaneously
Small intestine recovers within 24 hours after laparotomy, the stomach recovers by 48 hours, and the colon recovers within 3 to 5 days.
You perform exploratory surgery on a 35-year-old male for presumed appendicitis. The terminal ileum is identified and noted to be edematous, inflamed, and beefy red. The cecum and appendix are normal in appearance. What should you do?
A. Abort the procedure and close
B. Perform an ileocecectomy with end ileostomy
C. Perform a right hemicolectomy
D. Perform an appendectomy
If the stump of the appendix is not involved by acute regional enteritis, most surgeons perform an appendectomy to eliminate appendicitis from the differential diagnosis should the patient develop right lower quadrant pain at a later date. In the absence of obstruction and fistula formation, the ileum should not be resected in the setting of acute regional enteritis.
Which of the following is the principal fuel used by the small intestine?
The principal fuel utilized by the small intestine is glutamine.
Which of the following statements regarding short gut syndrome is false?
A. The diagnosis of short gut syndrome, the inability to absorb enough water and nutritional elements to be off TPN, is clinical
B. In the absence of an ileocecal valve, the length of bowel generally needs to be 100 cm
C. In the absence of an ileocecal valve, the length of bowel generally needs to be 75 cm
D. In the presence of an ileocecal valve, the length of bowel generally needs to be 50 cm
In general, the length of bowel needs to be at least 75 cm in the absence of an ileocecal valve and 50 cm with an ileocecal valve to avoid TPN.
A 55-year-old female undergoes liver resection for metastatic carcinoid tumor.
Upon induction, she becomes flushed, tachycardic to HR = 120 bpm, and hypotensive with a systolic blood pressure of 70 mm Hg. Her end-tidal CO2 is normal and she remains normothermic. What is the next best step in management?
B. Administer dexamethasone
This patient is experiencing carcinoid crisis, which manifests with flushing, tachycardia, hypotension, and bronchospasm. Treatment consists of octreotide 50 to 100 pg administered as an IV bolus.
Which of the following is the strongest layer of the small intestine?
The submucosa consists of dense connective tissue and is the strongest layer of the small intestine.
An 80-year-old male on NSAIDs for arthritis presents with 6 hours of severe abdominal pain. He is hypotensive and tachycardic but stabilizes after 2 L of normal saline. He is subsequently diagnosed with a perforated duodenal ulcer. What operation would you perform?
A. Omental patch of the perforation
B. Close the perforation primarily
C. Perform a gastric resection encompassing the perforation
D. Repair the perforation and perform a truncal vagotomy
E. Repair the perforation and perform a highly selective vagotomy
The perforation is best closed with an omental patch (Graham patch). After surgery, the patient should be taken off of his NSAIDs and treated for H. pylori. A definitive operation should only be performed on a hemodynamically stable patient.