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Splenic-flexure syndrome

In medicine, splenic-flexure syndrome is a chronic disorder that seems to be caused by trapped gas at bends (flexures) in the colon. Symptoms include bloating, muscle spasms of the colon, and upper abdominal discomfort.

Splenic-flexure syndrome often accompanies IBS.

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Teenage Marijuana Use Declines While Ecstasy Use Increases - Statistical Data Included
From AORN Journal, 2/1/01

Fewer US teenagers are smoking marijuana, continuing a three-year trend; however, an increasing number are using ecstasy, according to a Nov 27, 2000, news release from the Partnership for a DrugFree America (PDFA). Although the decrease in marijuana use is positive and the usage numbers of ecstasy are lower than those of marijuana, the increase demands attention.

The PDFA surveyed 7,290 teenagers throughout the United States. Results show overall drug use was stable between 1999 and 2000 and down significantly from 1997. The purpose of the study was to monitor trends in drug use and important drug-related attitudes that drive drug use.

Trial use of marijuana has decreased 10% since 1997. In 1997, 44% of teenagers reported trying marijuana at least once compared to 40% in 2000. During the same time period, past-year marijuana use decreased from 36% to 33%. Most significantly, regular use or past-month use declined 13% in this three-year period.

Teenagers' attitudes and perceptions regarding marijuana are following a positive trend, with more teenagers rejecting the drug. Teenagers believe the drug will make them lonely, boring, or act stupidly or foolishly. Fewer see marijuana use around them, and fewer believe most people will use the drug. The trial use of ecstasy, however, increased significantly during the past year (ie, from 7% to 10%) and has doubled since 1995, when only 5% of teenagers reported ever using the drug.

Ecstasy is a synthetic stimulant usually taken orally in pill form. Other names for the drug include "X," "E," and "the love drug." The drug has flooded the US market from the Netherlands in recent years, according to the release. Ecstasy is known as a club drug and is part of the dance club and all-night "rave" scene. Trial use of the drug is on par with teenage trial use of cocaine, crack, and lysergic acid diethylamide (LSD). More US teenagers have experimented with ecstasy than with heroin.

According to the release, significant increases have been seen in teenage use of methamphetamines and inhalants. Use of cocaine, crack, heroin, and LSD has remained stable, and use of other illicit drugs remains at or near decade high levels.

In 1979, US teenage drug use peaked. It declined steadily throughout the 1980s and began to climb again from 1991 to 1992. This trend continued until 1997. Since then there has been a slow, steady decline. Between 1999 and 2000, usage rates stabilized.

Teens Continuing to Turn Away From Marijuana, But Small, Increasing Number Take to Ecstasy (news release, New York: Partnership for a Drug-Free America) 1-2. Available from asp. Accessed 11 Dec 2000.



1. The small intestine comprises the duodenum, jejunum, and ileum.

a. true

b. false

2. The large intestine comprises

a. the cecum, ascending colon, descending colon, sigmoid colon, and anus.

b. the transverse colon, rectum, and anus.

c. the ascending, transverse, descending, and sigmoid colon.

d. the cecum; the ascending, transverse, descending, and sigmoid colon; and rectum and anus.

3. The large intestine begins at the

a. cardiac sphincter.

b. ileocecal valve.

c. the cecum.

d. the colon.

4. The cecum attaches to the -- and extends approximately two and one-half inches below it.

a. ileum

b. appendix

c. jejunum

d. colon

5. In an adult, the cecum usually is adherent to the anterior wall of the peritoneal cavity and has a serosal covering on its posterior wall only.

a. true

b. false

6. The cecum forms a blind pouch from which the -- projects.

a. rectum

b. appendix

c. jejunum

d. colon

7. The colon is divided into -- parts

a. two

b. three

c. four

d. five

8. What part of the colon extends from the ileocecal valve to the hepatic flexure?

a. ascending

b. descending

c. transverse

d. sigmoid

9. What part of the colon is approximately 20 inches long and begins at the hepatic flexure and ends at the splenic flexure?

a. ascending

b. descending

c. transverse

d. sigmoid

10. What part of the colon extends downward from the splenic flexure to the area just below the iliac crest and is approximately seven inches long?

a. ascending

b. descending

c. transverse

d. sigmoid

11. What portion of the colon passes over the pelvic rim into the pelvic cavity and lies partly in the abdomen and partly in the pelvis?

a. ascending

b. descending

c. transverse

d. sigmoid

12. The wall of the colon is made up of taeniae coli, epiploic appendices, and haustra.

a. true

b. false

13. What represents the incomplete, longitudinal, axial muscle layer of the colon that is distributed around its circumference?

a. taeniae coli

b. epiploic appendices

c. haustra

14. What are fatty appendages along the bowel that have no particular function?

a. taeniae coli

b. epiploic appendices

c. haustra

15. What are sacculations that are the outpouchings of the bowel wall between the longitudinal, axial strips of muscle?

a. taeniae coli

b. epiploic appendices

c. haustra

16. Colorectal polyps, diverticula, and inflammatory bowel disease (IBD) are cancerous conditions of the bowel that require surgical treatment.

a. true

b. false

17. Colorectal polyps are growths on the large intestine that rarely cause symptoms but that can progress to cancerous lesions if left untreated.

a. true

b. false

18. Diverticulosis is present in approximately one-half of all Americans ages -- to --.

a. 50 to 60

b. 60 to 80

c. 70 to 85

d. 80 to 90

19. What is the difference between diverticulosis and diverticulitis?

a. Diverticulosis is the presence of outpouchings in the bowel, and diverticulitis is the infection or inflammation of those outpouchings.

b. Diverticulosis is the infection or inflammation of outpouchings in the bowel, and diverticulitis is the presence of those outpouchings

20. Diverticulosis typically involves the sigmoid and descending colon, although infrequently, it involves the right colon and can have symptoms similar to appendicitis.

a. true

b. false

21. Previous bouts of infection or inflammation in diverticula can lead to colonic segments with chronic and acute inflammation associated with adhesions to the surrounding organs and loops of small bowel.

a. true

b. false

22. The term inflammatory bowel disease describes a group of chronic diseases that cause inflammation or ulceration of the small and large intestines. What are some examples of these conditions?

a. colorectal polyps and diverticula

b. Crohn's disease and ulcerative colitis

c. irritable bowel syndrome and Crohn's disease

d. ulcerative colitis and diverticulitis

23. Which statement is true about IBD?

a. It is an acute condition that occurs only in adolescents.

b. It is a chronic condition that lasts a few months and can occur at any age.

c. It is a chronic condition that lasts months to years; it occurs in adolescents and young adults, but can occur in older people.

d. It is a chronic condition that lasts weeks to years and it occurs in older people and occasionally younger people.

24. Twenty percent of people who are diagnosed with IBD often have blood relatives with this condition.

a. true

b. false

25. What group is most likely to experience IBD?

a. men and women of Jewish descent

b. Caucasian men

c. African-American men and women

d. Asian women

26. During a surgical procedure, what can be seen as the result of the acute and chronic inflammation of Crohn's disease?

a. hemorrhage and necrosis of the involved colonic segment

b. paleness and thickening of the involved colonic segment

c. necrosis and infection of the involved colonic segment

d. stenosis and adhesions of the involve3 colonic segment

27. What percent of patients with Crohn's disease undergo surgery at some point in their illness?

a. 25%

b. 45%

c. 60%

d. 70%

28. Inflammatory bowel disease is treated with anti-inflammatory medications, and surgery is reserved for nonresponsive cases.

a. true

b. false

29. Patient with diverticular disease present with what symptoms?

a. constipation alternating with diarrhea, and anemia

b. rectal bleeding, abdominal pain, and anemia

c. rectal bleeding, abdominal pain, hemocult positive stools, and anemia

d. rectal bleeding, abdominal pain, hemocult negative stools, and constipation

30. Patients with IBD present with the same symptoms as those with diverticular disease but also can experience what additional symptoms?

a. weight loss and diarrhea

b. constipation, weight loss, and electrolyte disturbances

c. abdominal cramps, diarrhea, and weight loss

d. weight loss, abdominal cramps, diarrhea, and electrolyte disturbances

31. Colectomy is the treatment for colon polyps that cannot be removed by colonoscope, diverticulitis that does not respond to antibiotic therapy, and IBD that does not respond to anti-inflammatory medication.

a. true

b. false

32. In patients with ulcerative colitis, the inflammatory process spreads proximally from the rectum and may involve the entire colon. What surgical procedure would these patients require?

a. laparoscopic colectomy

b. total proctocolectomy with ileostomy

c. colon resection via laparotomy

d. colonoscopic removal of the involved segment

33. When is the laparoscopic approach contraindicated?

a. in patients with extensive adhesions from previous surgeries, morbidly obese patients, pregnant patients, and in patients with bleeding disorders

b. in patients who are morbidly obese, have bleeding disorders, or are pregnant

c. in patients with extensive adhesions, in women, and in patients who are

morbidly obese

d. in critically ill patients

34. It is possible to perforate which three areas during laparoscopic colectomy?

a. bladder, uterus, and ureters

b. rectum, transverse colon, and small bowel

c. bladder, transverse colon, and uterus

d. rectum, small bowel, and ureters

35. Risks of the laparoscopic colectomy also include

a. ileostomy and rectovaginal fistula.

b. enterotomy, colotomy, and colovesical fistula.

c. colostomy and colovesical fistula.

d. ureterostomy, ileostomy, and colovesical fistula.

36. Postoperative complications include anastomotic leaks and strictures, ileus, lung atelectasis, and wound infection.

a. true

b. false

37. The major benefits from using a laparoscopic approach are

a. increased postoperative comfort and cosmesis.

b. decreased analgesic requirements, increased postoperative comfort, and cosmesis.

c. less fatigue, decreased analgesic requirements, increased postoperative comfort, and cosmesis.

d. less fatigue, decreased analgesic requirements, increased postoperative comfort, .cosmesis, and shorter recovery period.

38. When interviewing a patient scheduled for laparosopic colectomy, the nurse must assess the patient's physical limitations (eg, previous hip or knee surgery, debilitating arthritis) to anticipate problems with what aspect of perioperative care?

a. placing the patient in lithotomy position

b. placing the patient in Trendelenberg's position

c. determining whether the patient can tolerate abdominal insufflation

d. determining if the patient is on medication for those limitations that would preclude surgery.

39. The preoperative bowel prep for a laparosopic colectomy begins 48 hours before surgery and includes a regular breakfast, then no solid foods or milk products; a clear liquid lunch; a phosphosoda laxative taken with eight ounces of clear liquid; an additional 24 ounces of clear fluid taken after lunch and again the following day at 8 AM; and prophylactic antibiotics started 24 hours before surgery taken at 1 PM, 2 PM, and 8 PM.

a. true

b. false

40. Screening patients for previous abdominal surgeries can alert the perioperative team members to the possible presence of --, which might increase the risk of converting from a laparosopic colectomy to a laparotomy.

a. uncontrolled bleeding

b. inability to tolerate abdominal insufflation

c. adhesions

d. implants

41. Screening for previous surgeries also helps the nurse assess the patient for --, which may affect intraoperative positioning and electrosurgical unit dispersive pad placement.

a. uncontrolled bleeding

b. inability to tolerate abdominal insufflation

c. adhesions

d. implants

42. When caring for a patient undergoing a laparosopic colectomy, the nurse's goal should be anticipating problems and being prepared to convert quickly to a laparotomy if necessary.

a. true

b. false

43. What things must the anesthesia care provider consider in regard to a patient undergoing a laparosopic low anterior resection and sigmoid colectomy?

a. the patient's age, previous surgery, and allergies

b. the patient's ability to tolerate anesthesia and abdominal insufflation

c. the patient's ability to tolerate anesthesia, abdominal insufflation, and Trendelenberg's position

d. the patient's age, previous surgery, allergies, and ability to tolerate anesthesia

44. After the patient has been placed in the lithotomy position in self-balancing, padded stirrups, what must the nurse assess and confirm?

a. the angle at which the patient's legs rest

b. the iliac, femoral, and dorsalis pedis pulses

c. bilateral posterior popliteal, posterior tibial, and dorsalis pedis pulses

d. bilateral femoral, posterior tibial, and posterior popliteal pulses

45. During the laparosopic low anterior resection and sigmoid colectomy procedure, what does the nurse ensure regarding the patient's circulation?

a. that scrubbed personnel do not lean on the patient's legs and compromise circulation

b. that the patient's color is good in his or her feet

c. that there are no pressure points

d. that the legs are taken from the stirrups periodically to relieve circulatory compromise

46. In positioning the patient for both a laparoscopically assisted right colectomy and a laparoscopic low anterior resection and sigmoid colectomy procedure, for what must the nurse assess the patient?

a. the presence of bilateral posterior popliteal, posterior tibial, and dorsalis pedis pulses

b. the patient is in supine position with arms tucked at his or her side

c. frequent elbow position checks to avoid finger and ulnar nerve damage

d. that scrubbed personnel do not lean on the patient's legs and compromise circulation

47. Which procedure commonly requires the insertion of ureteral catheters?

a. a laparoscopically assisted right colectomy

b. a laparoscopic low anterior resection, and sigmoid colectomy

48. The surgeon infiltrates the tissues surrounding the incisions with bupivacaine hydrochloride to

a. reduce the pain of suturing as the patient wakes.

b. reduce postoperative pain.

c. relieve the abdominal discomfort seen in laparoscopic cases.

d. prevent wound infection.

49. What potential complication of laparoscopic bowel surgery causes a crackling feeling to the skin of the neck and clavicular area from insufflation gas dissecting into the surrounding tissue?

a. gas gangrene

b. atelectasis

c. subcutaneous emphysema

d. esophageal reflux

50. This dissection of insufflation gas usually resolves within a few -- and is relatively minor, but it may cause alarm for the patient and his or her family members.

a. minutes

b. hours

c. days

d. weeks

AORN, Association of periOperative Registered Nurses, is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. AORN recognizes this activity as continuing education for registered nurses. This recognition does not imply that AORN or the ANCC's Commission on Accreditation approves or endorses any product included in the activity. AORN maintains the following state board of nursing provider numbers: Alabama ABNP0075, California CEP13019, Florida FBN 2296, and Kansas LT0114-0316. Check with your state board of nursing for acceptability of education activity for relicensure.

Professional nurses ore invited to submit manuscripts for the Home Study Program. Manuscripts or queries should be sent to Editor, AORN Journal, 2170 S Parker Rd, Suite 300, Denver, CO 80231-5711. As with oil manuscripts sent to the Journal, papers submitted for Home Study Programs should not have been previously published or submitted simultaneously to any other publication.

COPYRIGHT 2001 Association of Operating Room Nurses, Inc.
COPYRIGHT 2001 Gale Group

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