Gastroenterology - Disorders of the Intestinal Tract
1. What is the function of enteric nerves in the muscularis layer of the in-
testines?: - helps the mucosal later secrete substances and do its own peristalsis
2. What is the function of the enteric nerves in the submucosa of the intestines?-
: - signal for motility and tells the glands when to secrete
3. What is the function of mucosa associated lymphoid tissue (MALT)?: - filters out
certain substances
4. What is the significance of the ileocecal valve?: - it must be CLOSED if there is no food moving
through it
- if it is OPEN, it will allow colon flora to move into the small intestine
5. Where is bile and B12 absorbed?: - terminal ileum
6. What is the significance of the terminal ileum?: - there are villi that perform reabsorption,
along with lymphoid cells
,7. Is the terminal ileum necessary for life?: - YES, which is why if it is removed, supplementation is
necessary
8. What shape is the transverse colon?: - triangular lumen
9. What is the shape of the sigmoid colon?: - vaccuous and large to hole fecal matter
10. What is the relevance of the dentate/pectinate line?: - also known as the anorectal
junction
- Above the dentate line is simple columnar epithelium
- below the dentate line is stratified squamous epithelium
11. Who is acute appendicitis MC in?: MC in M>F, ages 10-30 y/o
12. What is the MCC of an acute abdomen requiring surgery?: - MCC = acute appendicitis
13. What is the MCC of acute appendicitis?: MCC = fecalith gets lodged into the lumen of the
appendix and causes back up of appendix secretions
14. What are other possible causes of appendicitis?: - Lymphoid tissue hypertrophy post-in-
fectious or due to IBD, which blocks the lumen
,- Inspissated barium post barium enema (dry and thickened barium gets stuck in appendix)
- Foreign body (chewing gum)
- Strictures (Crohn's disease)
- Tumors (mucocele, carcinoid, carcinoma, endometrioma)
- One week post colonoscopy (due to bowel prep and air)
, 15. What are symptoms of acute appendicitis?: - vague periumbilical pain, which localizes to the
RLQ
- anorexia
- nausea with or without vomiting
- obstipation
16. What symptoms occur if someone has a retrocecal appendix and develops
appendicitis?: Atypical symptoms
- RUQ pain
- flank pain
17. What are PE signs of acute appendicitis?: - mildly febrile
- tachycardiac
- McBurney's point = point of maximal tenderness (both DIRECT and rebound tenderness with palpation, percussion,
cough, hop, heel strike)
- TTP in RLQ
- (+) Psoas and (+) Obturator sign
- (+) Rovsing's sign (referred TTP when pressing on the LLQ and RLQ pain is felt)
- cutaneous hyperesthesia at T10
- IF peritonitis develops -> rigidity, involuntary guarding, quiet/absent bowel sounds
1. What is the function of enteric nerves in the muscularis layer of the in-
testines?: - helps the mucosal later secrete substances and do its own peristalsis
2. What is the function of the enteric nerves in the submucosa of the intestines?-
: - signal for motility and tells the glands when to secrete
3. What is the function of mucosa associated lymphoid tissue (MALT)?: - filters out
certain substances
4. What is the significance of the ileocecal valve?: - it must be CLOSED if there is no food moving
through it
- if it is OPEN, it will allow colon flora to move into the small intestine
5. Where is bile and B12 absorbed?: - terminal ileum
6. What is the significance of the terminal ileum?: - there are villi that perform reabsorption,
along with lymphoid cells
,7. Is the terminal ileum necessary for life?: - YES, which is why if it is removed, supplementation is
necessary
8. What shape is the transverse colon?: - triangular lumen
9. What is the shape of the sigmoid colon?: - vaccuous and large to hole fecal matter
10. What is the relevance of the dentate/pectinate line?: - also known as the anorectal
junction
- Above the dentate line is simple columnar epithelium
- below the dentate line is stratified squamous epithelium
11. Who is acute appendicitis MC in?: MC in M>F, ages 10-30 y/o
12. What is the MCC of an acute abdomen requiring surgery?: - MCC = acute appendicitis
13. What is the MCC of acute appendicitis?: MCC = fecalith gets lodged into the lumen of the
appendix and causes back up of appendix secretions
14. What are other possible causes of appendicitis?: - Lymphoid tissue hypertrophy post-in-
fectious or due to IBD, which blocks the lumen
,- Inspissated barium post barium enema (dry and thickened barium gets stuck in appendix)
- Foreign body (chewing gum)
- Strictures (Crohn's disease)
- Tumors (mucocele, carcinoid, carcinoma, endometrioma)
- One week post colonoscopy (due to bowel prep and air)
, 15. What are symptoms of acute appendicitis?: - vague periumbilical pain, which localizes to the
RLQ
- anorexia
- nausea with or without vomiting
- obstipation
16. What symptoms occur if someone has a retrocecal appendix and develops
appendicitis?: Atypical symptoms
- RUQ pain
- flank pain
17. What are PE signs of acute appendicitis?: - mildly febrile
- tachycardiac
- McBurney's point = point of maximal tenderness (both DIRECT and rebound tenderness with palpation, percussion,
cough, hop, heel strike)
- TTP in RLQ
- (+) Psoas and (+) Obturator sign
- (+) Rovsing's sign (referred TTP when pressing on the LLQ and RLQ pain is felt)
- cutaneous hyperesthesia at T10
- IF peritonitis develops -> rigidity, involuntary guarding, quiet/absent bowel sounds
