Chapter 29: Small Bowel

Chapter 29. Small Bowel

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The most common cause of small bowel obstruction is

A. Intra-abdominal adhesions

B. Neoplasms

C. Intussusception

D. Crohn’s disease

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.

The treatment of small bowel obstruction includes

A. Nasogastric suction

B. Fluid and electrolyte resuscitation

C. Laparoscopic adhesiolysis in highly selected case

D. All of the above

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.

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

A. The most common cause is the arterial embolism.

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

C. Deep venous thrombosis can be a cause.

D. Abdominal pain is the main clinical finding.

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).

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

Which sentence about small bowel tumors is correct?

A. Adenomas are more common in the distal ileum.

B. The most common neoplasm is GIST.

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

D. Carcinoid syndrome develops in the presence of liver metastases.

D. Carcinoid syndrome develops in the presence of liver metastases. Adenomas are the most common benign tumors of the small intestine. The duodenum is the most common site of involvement, and the lesion most commonly noted is the villous adenoma. These lesions tend to involve the region of the ampulla of Vater. Malignant tumors tend to increase in frequency from proximal to distal, with the exception of adenocarcinomas which are most frequent in the duodenum. Adenocarcinoma is the most common histologic type (45%), followed by carcinoids (30%), lymphomas (15%), sarcomas, and GISTs (10%). Peutz-Jeghers syndrome is characterized by diffuse gastrointestinal hamartomas and mucocutaneous pigmentation. The malignant potential of this polyposis is very small.

Carcinoid tumors produce symptoms secondary to hormone production, including hot flashes, bronchospasms and arrhythmias. This constellation of symptoms, called carcinoid syndrome, occurs when the liver is not able to metabolize the active substances produced by the carcinoid tumor.

Which is the most common intestinal fistula in patients with Crohn’s disease:

A. Ileosigmoid

B. Ileovesical

C. Ileocutaneous

D. Ileovaginal

A. Ileosigmoid fistula is a common complication of perforating CD of the terminal ileum. Ileosigmoid fistula is a common complication of perforating CD of the terminal ileum. Typically, the inflamed terminal ileum adheres to the sigmoid colon that is otherwise healthy. Ileovesical fistulae occur in approximately 5% of CD patients. Although hematuria and fecaluria are virtually diagnostic of ileovesical fistula, these symptoms are absent in almost 30% of cases. Enterovaginal and ECF are rare fistulas caused by perforating small bowel disease draining through the vaginal stump in a female who has previously undergone a hysterectomy or through the abdominal wall, usually at the site of a previous scar.

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Chapter 29: Small Bowel

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Chapter 29. Small Bowel

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