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Chapter 19. Small Intestine
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Strictureplasty is indicated in a Crohn patient with:
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A. Fistula at the level of the stricture
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B. Intraabdominal abscess
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C. Multiple areas of stenosis
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D. Multiple intestinal fistulas
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Answer: C. Indications for strictureplasty 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 intraabdominal abscess.
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A Heineke-Mikulicz strictureplasty can be performed for strictures <12 cm in length, a Finney strictureplasty 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.
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How do adults with Meckel diverticulum usually present?
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Answer: D. 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.
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Which of the following forms of calcium supplementation should be administered to gastric bypass patients?
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Answer: A. Calcium citrate is the supplementation of choice for patients with low acid exposure.
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Which of the following is the FIRST to recover from postoperative ileus?
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D. The stomach, small intestine, and colon recover from ileus simultaneously
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Answer: B. The small intestine recovers within 24 hours after laparotomy, the stomach recovers by 48 hours, and the colon recovers within 3 to 5 days.
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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 ...