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Fiser Absite > 35 - Small Intestine > Flashcards

35 - Small Intestine Flashcards

1
Q

Portion of the duodenum containing ampulla of Vater and duct of Santorini

A

2nd (descending)

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2
Q

Retroperitoneal portions of the duodenum

A

2nd (descending)

3rd (transverse)

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3
Q

Transition point of 3rd and 4th parts of duodenum

A

Acute angle at aorta (posterior) and SMA (anterior)

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4
Q

Vascular supply of duodenum

A

Superior (off GDA) and inferior (off SMA) pancreaticoduodenal arteries

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5
Q

Length of jejunum

A

100cm

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6
Q

Maximum site of all intestinal absorption

A

Jejunum

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7
Q

Length of ileum

A

150cm

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8
Q

Vascular supply of jejunum and ileaum

A

SMA

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9
Q

Enzymes of the intestinal brush border cells (4)

A

Maltase
Sucrase
Dextrinase
Lactase

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10
Q

Intestinal cells that secrete mucin

A

Goblet cells

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11
Q

Intestinal cells that secrete secretory granules and enzymes

A

Paneth cells

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12
Q

Intestinal cells that secrete 5-hydroxytryptamine (5HT)

A

Enterochromaffin cells

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13
Q

Intestinal cells that secrete alkaline solution

A

Brunner’s glands

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14
Q

Intestinal cells that represent lymphoid tissue, increased in ileum

A

Peyer’s patches

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15
Q

Antigen presenting cell in intestinal wall

A

M-cells

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16
Q

Migrating motor complex for gut motility (4 phases)

A

Phase 1 - rest
Phase 2 - acceleration/gallbladder contraction
Phase 3 - Peristalsis
Phase 4 - Deceleration

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17
Q

Hormone acting on migrating motor complex and which phase does it act on

A

Motilin, phase 3 (peristalsis)

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18
Q

Percentage of bile salts/acid reabsorbed

A

95%

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19
Q

Where is non-conjugated and conjugated bile salts reabsorbed and which is passively vs actively reabsorbed

A

Non-conjugated (50% passive absorption) - 45% ileum, 5% colon
Conjugated (50% active absorption w/ Na/K ATPase) - 50% terminal ileum

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20
Q

Symptoms of short-gut syndrome (3)

A

steatorrhea, nutritional deficiency (B12) and weight loss

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21
Q

Check for fecal fat

A

Sudan Red Stain

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22
Q

Checks for B12 absorption (in urine)

A

Schilling test

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23
Q

Amount of bowel needed to survive without TPN

A

75cm (50cm w/ intact ileocecal valve)

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24
Q

Tx for short gut syndrome (3)

A

Fat restriction
PPI
Lomotil

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25
Q

Steatorrhea is deficiency in

A

Fat soluble vitamins (ADEK) and essential amino acids

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26
Q

Non-healing fistula causes (FRIENDSS)

A 
Foreign body
Radiation
Inflammatory bowel dz/Infection
Epithelialization
Neoplasm
Distal obstruction
Sepsis
Steroids
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27
Q

MCC of small bowel obstruction without and with previous surgery respectively

A

Without surgery - hernia

With surgery - adhesion

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28
Q

MCC of large bowel obstruction without and with previous surgery respectively

A

Without surgery - cancer

With surgery - cancer

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29
Q

Signs of gallstone ileus (Rigler’s triad)

A

Air in biliary tree
Stone outside gallbladder on imaging
Small bowel obstruction

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30
Q

SBO from gallstone usually in

A

Terminal ileum

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31
Q

Gallstone ileus caused by fistula btn

A

gallbladder and 2nd portion of duodenum

32
Q

Meckel’s diverticulum cause by

A

Failure of closure of omphalomesenteric duct

33
Q

Types of tissues found in Meckel’s and which is most common

A

Pancreatic (most common) and gastric (most likely symptomatic w/ bleeding)

34
Q

Most common presentation of Meckel’s in adults

A

Obstruction

35
Q

Indication for segmental resection of Meckel’s (3)

A

Complicated diverticulitis (perforated)
Neck > 1/3 diameter of normal bowel lumen
Diverticulitis involving the base

36
Q

Rule of 2’s of Meckel’s diverticulum (name 4-6)

A 
2 ft from ileocecal valve
2% of population
Within first 2 yrs of life w/ bleeding
2 types of mucosal tissues
2 times more common in males
2 inches long
37
Q

Management of juxta-ampullary duodenal diverticula with biliary and pancreatic sxs

A

Biliary - Choledochojejunostomy

Pancreatic - ERCP with stent

38
Q

Most common involved segment for Crohn’s

A

Terminal ileum

39
Q

Percentage for initial presentation of Crohn’s (terminal ileum, small bowel only, colon only, perianal)

A

TI - 40%
SB - 20%
Colon - 35%
Perianal - 5%

40
Q

Medical tx for Crohn’s (maintenance and acute flare)

A

Maintenance - Sulfasalazine and loperamide

Acute - Steroids

41
Q

Medical tx for Crohn’s fistulas or steroid-resistant

A

Remicade (Infliximab)

42
Q

Percentage of Crohn’s eventually needing operation

43
Q

Tx of abscess in Crohn’s

A

Percutaneous drainage

44
Q

Surgical margins for Crohn’s resection

A

No clear margin, 2cm from gross dz

45
Q

Serotonin produced by which intestinal cells

A

Enterochromaffin (Kulchitsky) cells

46
Q

Breakdown product of serotonin, where can you measure it

A

5-HIAA, measured in urine

47
Q

Hallmark sxs of carcinoid syndrome (2)

A

Flushing (kallikrein)

Diarrhea (Serotonin)

48
Q

Cause of carcinoid syndrome

A

Bulky liver metastases

49
Q

Best study for LOCALIZING carcinoid tumor not seen on CT

A

Octreotide scan

50
Q

Highest sensitivity for DETECTING carcinoid tumor

A

Chromogranin A level

51
Q

Most common site of carcinoid tumor

52
Q

Indication for appendectomy vs right hemicolectomy of appendix carcinoid

A

Appendectomy - <2cm and NOT involving base of appendix

R hemicolectomy - >/= 2cm OR involving base of appendix

53
Q

Chemo regimen for unresectable carcinoid disease

A

5-FU and streptozocin

54
Q

Tx for flushing carcinoid sx

A

Alpha-blockers (phenothiazine)

55
Q

Can result in falsely elevated 5-HIAA levels

56
Q

Most common location of small bowel adenomas

57
Q

Puetz-Jeghers syndrome method of inheritance

A

Autosomal dominant

58
Q

Puetz-Jeghers syndrome most common extra intestinal malignancy

A

Breast Cancer

59
Q

Most common MALIGNANT small bowel tumor

A

Adenocarcinoma

60
Q

Highest proportion of small bowel adenocarcinoma

61
Q

Pts needs a Whipple if adenocarcinoma involving this portion of duodenum

A

2nd (transverse)

62
Q

Small bowel Leiomyosarcoma most common locations

A

Jejunum and ileum (most extraluminal)

63
Q

Small bowel lymphoma most common location

64
Q

Cell type for small bowel lymphoma

A

Non-Hodgkin Lymphoma B cell type

65
Q

Most common stoma infection cause

66
Q

Cause of diversion colitis

A

Lack of short chain fatty acids (tx with SCFA enemas)

67
Q

MCC of stomal stenosis

68
Q

MCC of fistula near stoma site

A

Crohn’s dz

69
Q

Conditions ncreased in pts with ileostomy due to loss of bile salts and HCO3

A

Gallstones and Uric acid kidney stones

70
Q

Area most likely to perforate in appendicitis

A

Midpoint of the antimesenteric border

71
Q

MCC of appendicitis in children

A

Lymphoid hyperplasia

72
Q

MMC appendicitis in adults

73
Q

Most common associations of appendicitis and pregnancy in 1st, 2nd and 3rd trimesters

A

1st - MMC acute abd pain
2nd - period when appendicitis most often OCCURS
3rd - period when appendicitis most often PERFORATEA

74
Q

MCC of death with appendix mucocele

75
Q

Sx (6) and Tx for typhoin enteritis (salmonella)

A

Sx - RLQ pain, diarrhea, fever, maculopapular rash, leukopenia, large mesenteric lymph nodes
Tx - Bactrim

Fiser Absite (14 decks)

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