Reference: Loftus EV Jr. "Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences." Gastroenterology. 2004.
Reference: M'Koma AE. "Crohn's disease: A review of the disease and its management." Journal of Health Care and Research. 2015.
Malnutrition and Related Causes: 10-20%
Reference: Tisdall R, et al. "The role of nutrition in inflammatory bowel disease." Gastroenterology Clinics of North America. 2006.
Colorectal Cancer: 5-10%
Reference: Itzkowitz SH, et al. "Cancer in patients with inflammatory bowel disease." Gastroenterology. 2007.
Other Causes (e.g., thromboembolism, liver disease): 10-15%
Reference: Rungoe C, et al. "Causes of death in patients with inflammatory bowel disease: a population-based study." Inflammatory Bowel Diseases. 2013.
Q3. Which of the following is not true about Pneumatosis intestinalis of small intestine?
a) It is seen equally and males and females
b) Most common location is subserosa in the jejunum
c) Operative Procedures are required in most of the cases
d) It is associated with COPD and immunodeficiency states
3. c Operation is not required unless a complication such as volvulus, hemorrhage, intestinal obstruction or perforation develops. Complications are seen in 1-3% cases.
On plain X-ray they appear as radio lucent areas in the ball wall which have to be distinguished from luminal intestinal gas
Sabiston 21 st edition
Q4. What is not true about blind loop syndrome?
a) It manifest as diarrheas, weight loss and deficiency of fat soluble vitamins.
b) Megaloblastic anemia is commonly seen
c) Surgery is almost always required to correct small bowel syndrome
d) Broad spectrum antibiotics are the treatment of choice
4.c
Blind lop syndrome is manifested by diarrhea, steatorrhea, megaloblastic anemia, weight loss, abdominal pain, and deficiencies of the fat-soluble vitamins (A, D, E, and K), as well as neurologic disorders.
It is caused by bacterial overgrowth in stagnant areas of the small bowel due to stricture, stenosis, fistulas, or diverticulum.
Surgery is required in very few cases
Surgical correction of the condition producing stagnation and blind loop syndrome produces a permanent cure and is indicated in those patients who require multiple rounds of antibiotics or are on continuous therapy.
Bacterial overgrowth can be diagnosed with cultures obtained through an intestinal tube or by indirect tests such as the 14C-xylose or 14C-cholylglycine breath tests. Once bacterial overgrowth and steatorrhea are confirmed, a Schilling test (57Co-labeled vitamin B12 absorption) may be performed next, which should reveal a pattern of urinary excretion of vitamin B12 resembling that of pernicious anemia (a urinary loss of 0% to 6% of vitamin B12 compared with the normal of 7% to 25%
Q5. What is not true about the immune mechanism in the small intestine?
a) Intestine contains more than 70% of IgA producing cells in the body
b)Ig A acts by activating the complement pathway
c)Ig A is produced by plasma cells in the lamina propria
d)Approximately 60% of the lymphoid cells are T cells
5. b
The intestine contains more than 70% of the IgA-producing cells in the body.
IgA is produced by plasma cells in the lamina propria.
IgA does not activate complement and does not enhance cell-mediated opsonization or destruction of infectious organisms or antigens, which sharply contrasts to the role of other immunoglobulins.
Secretory IgA inhibits the adherence of bacteria to epithelial cells and prevents their colonization and multiplication. In addition, secretory IgA neutralizes bacterial toxins and viral activity and blocks the absorption of antigens from the gut.
Q6. What is not true about malrotation of the small intestine
a) In Incomplete rotation the rotation is arrested at 180 degree
b) The small intestine lies on the right with caecum in the midline
c) Ladd's band extends from the Right upper quadrant to the caecum
d) Hyper rotation is the most common form of intestinal malrotation
6.d
There are several degrees of rotational abnormality.
Nonrotation is characterized by failure of counterclockwise rotation after return of the midgut to the abdominal cavity.
In incomplete rotation, the counterclockwise rotation is arrested at around 180 degrees. These are the most common forms of malrotation.
Associated with this abnormal fixation is a narrow intestinal mesentery and Ladd's bands. Ladd's bands represent the retroperitoneal attachments that normally fix the cecum and ascending colon to the posterior abdominal wall. Because the right colon is more medial, the bands extend across the duodenum from the right upper quadrant to the cecum and ascending colon.
direction around the SMA. The duodenum assumes an anterior position and the colon lies posterior to the duodenum and the SMA.
If the counterclockwise rotation extends beyond 270 degrees, the cecum comes to rest in the left hypochondrium position. This rare form is called hyper-rotation
