Wednesday, 5 October 2011
Complete mechanical small bowel obstruction can cause dehydration by:
A. Interfering with oral intake of water.
B. Inducing vomiting.
C. Decreasing intestinal absorption of water.
D. Causing secretion of water into the intestinal lumen.
E. Causing edema of the intestinal wall
Answer: ABCDE
DISCUSSION: One of the most important events during simple mechanical small bowel obstruction, loss of water and electrolytes from the body, is caused mainly by intestinal distention. Distention may produce reflex vomiting. Distention causes intestinal secretion. Distention causes decreased absorption.
Wednesday, 5 October 2011 0
Tuesday, 4 October 2011
History and physical examination permit the diagnosis of intestinal obstruction in most cases. Which of the 
following are important for the clinical diagnosis of small bowel obstruction?
following are important for the clinical diagnosis of small bowel obstruction?A. Crampy abdominal pain.
B. Fever.
C. Vomiting.
D. Abdominal distention.
E. Leukocyte count above 12,000.
F. Abdominal tenderness.
Answer: ABCDF
DISCUSSION: History and physical examination permit the diagnosis of intestinal obstruction. Any patient having crampy abdominal pain, vomiting, obstipation, abdominal distention, abdominal tenderness, and peristaltic rushes should be managed for intestinal obstruction until the diagnosis can confidently be excluded.
Tuesday, 4 October 2011 1
All of the following statements about the embryology of Meckel's diverticulum
are true except:
are true except:A. Meckel's diverticulum usually arises from the ileum within 90 cm. of the ileocecal valve.
B. Meckel's diverticulum results from the failure of the vitelline duct to obliterate.
C. The incidence of Meckel's diverticulum in the general population is 5%.
D. Meckel's diverticulum is a true diverticulum possessing all layers of the intestinal wall.
E. Gastric mucosa is the most common ectopic tissue found within a Meckel's diverticulum.
Answer: C
DISCUSSION: Meckel's diverticulum is a true diverticulum containing all layers of the intestinal wall, usually arising from the antimesenteric border of the ileum 45–90 cm. proximal to the ileocecal valve. It is a vestige of the omphalomesenteric or vitelline duct, which usually undergoes complete obliteration during the seventh week of gestation. Autopsy studies have estimated the incidence of Meckel's diverticulum to be 1% to 2% with men being more commonly affected than women by a ratio of 2:1. Gastric mucosa is present in 50% of all Meckel's diverticula, but in over 75% of symptomatic individuals.
Meckel's diverticulum most commonly presents as:
A. Gastrointestinal bleeding.
B. Obstruction.
C. Diverticulitis.
D. Intermittent abdominal pain.
Answer: A
DISCUSSION: It is estimated that only 4% of patients who possess a Meckel's diverticulum will become 
symptomatic during their lifetimes.
symptomatic during their lifetimes.The most common clinical presentation is incidental identification during abdominal exploration. Symptomatic presentations are secondary to hemorrhage, small bowel obstruction, diverticulitis, perforation, associated umbilical abnormalities, and tumors. Over half of patients presenting with symptoms are under the age of 2.
The most common clinical problem associated with Meckel's diverticulum is gastrointestinal bleeding presenting as bright red blood per rectum. The usual source of the bleeding is a chronic acid-induced ileal ulcer in the ileum adjacent to a Meckel's diverticulum that contains gastric mucosa. Another common symptom associated with a Meckel's diverticulum is intestinal obstruction.
The cause of this obstruction may be volvulus of the small bowel around a diverticulum associated with a fibrotic band attached to the abdominal wall, intussusception, or rarely, incarceration of the diverticulum in an inguinal hernia (Littre's hernia).
Volvulus is usually an acute event and if allowed to progress, may result in strangulation of the involved bowel. In intussusception, a broad-based diverticulum invaginates and then is carried forward by peristalsis.
A 49-year-old man presents to the emergency room because of melena of 3 days' duration. He denies 
abdominal pain. Vital signs reveal a resting pulse of 104 per minute and a 25-mm Hg orthostatic drop in BP. Physical findings include bilateral temporal wasting, pale conjunctivae, spider angiomas on his upper torso, muscle wasting, hepatosplenomegaly, and hyperactive bowel sounds without abdominal tenderness to palpation. His stool is melenic. Nasogastric tube aspiration reveals coffee grounds material. Hematocrit is 31%. The appropriate next step in the management of this man's illness would be to
abdominal pain. Vital signs reveal a resting pulse of 104 per minute and a 25-mm Hg orthostatic drop in BP. Physical findings include bilateral temporal wasting, pale conjunctivae, spider angiomas on his upper torso, muscle wasting, hepatosplenomegaly, and hyperactive bowel sounds without abdominal tenderness to palpation. His stool is melenic. Nasogastric tube aspiration reveals coffee grounds material. Hematocrit is 31%. The appropriate next step in the management of this man's illness would be toA. Pass a Sengstaken-Blakemore tube.
B. Obtain an upper GI series.
C. Insert a transjugular intrahepatic portosystemic shunt (TIPS).
D. Obtain immediate visceral angiography.
E. Perform upper endoscopy
Explanation:
After this patient has been hemodynamically stabilized, the next mostimportant step is to perform a diagnostic/therapeutic upper endoscopy. If the source of his bleeding is from esophageal varices, then these can be obliterated with sclerosis or, preferably, endoscopic band ligation. The use of a Sengstaken-Blakemore tube should be reserved for patients in whom upper endoscopywas unsuccessful in controlling the hemorrhage. A TIPS should be considered in patients in whom medical and endoscopic therapy have failed. Barium studies have no role in the evaluation of patients with suspected variceal hemorrhage
Sunday, 18 September 2011
| Causes of Jaundice |
| ABCDEFGHIJ A nesthetics (e.g. halothane) B lood transfusions C ontacts D rugs E thanol F oreign travel G allstones/Gilberts H epatitis I diopathic/IVDA J ob (e.g. farmers, sewage workers) |
Sunday, 18 September 2011 0
| Gastric Malignancy |
| The 5As A nemia A norexia A sthenia A canthosis Nigricans A blood group |
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