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Chapter 19. Small Intestine

Strictureplasty is indicated in a Crohn patient with:

A. Fistula at the level of the stricture

B. Intraabdominal abscess

C. Multiple areas of stenosis

D. Multiple intestinal fistulas

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.

  • 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.

How do adults with Meckel diverticulum usually present?

A. Hemorrhage

B. Perforation

C. Meckel diverticulitis

D. Obstruction

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.

Which of the following forms of calcium supplementation should be administered to gastric bypass patients?

A. Calcium citrate

B. Calcium chloride

C. Calcium oxide

D. Calcium hydroxide

Answer: A. 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?

A. Stomach

B. Small intestine

C. Colon

D. The stomach, small intestine, and colon recover from ileus simultaneously

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.

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 ...

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