I. For each area of gastrointestinal activity, select the location in which this activity is most likely to occur.

1. The principal area of bile salt intake.

2. The area from which the last absorption occurs.

3. The chief site of iron absorption.

4. The chief site of vitamin B12 absorption.

5. The only area in which cells do not secrete or

produce digestive enzymes. 6. The area in which absorption is restricted to

water and electrolities.

2. What is it?

A strong muscular tube which, conveys food from the oropharynx to the stomach. The initiation of swallowing is a voluntary act involving the skeletal musculature of the oropharynx which is then succeded by a strong peristaltic reflex which conveys the bolus of food or drink to the stomach. Food or drink do not normally remain here for more then a few seconds. Below the diaphragm it passes for a short distance in the abdom­inal cavity before joining the stomach at an acute angle, (o ... s).

2. What organ is it?

It is dilated part of the gastrointestinal tract in which injested food is retained for 2 hours or longer so as to undergo mechanical and chemi­cal reduction to form chyme. It is divided into four regions: the cardia, fundus, body (corpus) and pylorus (pyloric antrum).

Texts for individual reading appendicitis

Appendicitis usually is preceded by obstruction due to a facalith or enlarged lymph node, and sometimes by stenosis or kinking of the organ.

1. stomach

2. duodenum

3. jejunum

4. ileum

5. colon

Inflammation results from this obstruction, and infection results from invasion of the appendicidal wall by any of the many bacteria pre­sent in the intestinal tract. With extension of the inflammation or infection to the peritoneal surface, the appendix becomes covered with a yellowish,

fibrinous exudate. It also becomes edematous and the blood supply is reduced. Finally, gangrene may occur, followed by perforation. A limited amount of thin cloudy peritoneal fluid may indicate the presence of bac­teria in the peritoneal cavity even in the absence of gangrene or perfora­tion.

Appendicitis is heralded by pain in the umbilical region, commonly accompanied by anorexia, nausea and vomiting. After several hours this referred pain shifts to the right lower quadrant, and is continuous, dull or severe, accentuated by coughing, sneezing, or jarring.

The anterior abdominal wall over the appendiceal area may be splint­ed voluntarily or involutarily. Localized tenderness in the right lower quadrant is the most common and dependable physical sign.

Acute appendicitis usually is associated with mild fever. Further ele­vations in temperature and leukocytosis often are indicative of gangrene, rupture, or spreading peritonitis. An abscess may develop as early as 3 days after onset of appendicitis.

Since the appendix may be located in almost any portion of the abdominal cavity, findings may very greatly from those described above. A retroperitoneal or retrocecal appendix will cause minimal muscle guard­ing and tenderness, and because of its proximity to the ureter may pro­duce a few blood cells in the urine. An appendix low in the pelvic cavity may cause tenderness only on rectal or vaginal examination. Because of congenital malrotation of the colon, the appendix may be situated subja­cent to the liver or on the left side of the abdominal cavity, and give symptoms referable to these areas.