Q1. Most common extra intestinal manifestation of Crohn's disease of small intestine
a) Ankylosing Spondylitis
b) Erythema Nodosum
d) Ureteral Obstruction
1.b Extra intestinal manifestations of Crohn's disease may be present in 30% of patients.
The most common symptoms are skin lesions, which include erythema nodosum and pyoderma gangrenosum. Others are arthritis and arthralgias, uveitis and iritis, hepatitis, peri cholangitis, and aphthous stomatitis.
In addition, amyloidosis, pancreatitis, and nephrotic syndrome may occur in these patients.
These symptoms may precede, accompany, or appear independently of the underlying bowel disease.
Sabiston 21 st edition, page 1261
Q2. Which of the following is the most common cause of death in Crohn's disease of small intestine
c) Electrolyte Disorders
d) Thromboembolic Phenomenon
2. a Crohn’s disease primarily attacks young adults in the second and third decades of life.
However, a bimodal distribution is apparent with a second smaller peak occurring in the sixth decade of life. Death rate in a person with Crohn's disease is 2-3 times higher than general population. Most common cause is malignancy of the small intestine and not any inflammatory condition.
Gastrointestinal cancer remains the leading cause of disease-related death in patients with Crohn's disease; other causes of disease-related deaths include sepsis, thromboembolic complications, and electrolyte disorders.
Ref Sabiston 20th page below Fig 49-26
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 less than 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 page 1294
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
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
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
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