Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery > Chapter 11 > Flashcards

Chapter 11 Flashcards

1
Q

How long is the small bowel?

What is its major function?

A

8 m

Absorb nutrients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three sections, and how long is each section?

A

Duodenum- 40 cm
Jejunum- 200 cm
Ileum- 300 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How are the jejunum and ileum covered and anchored?

A

Covered by visceral peritoneum and tethered to posterior anterior wall by a mesentery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Duodenal bulb

A

Superior to the pancreatic head and anterior to the gastroduodenal artery and common bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Position and blood supply of the duodenal bulb

A

Intraperitoneal position

Blood supply from the supraduodenal branch of the hepatic artery and the gastroduodenal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The duodenal bulb is the site of _____ of duodenal ulceration

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Position of the second part of the duodenum

A

Borders the head of the pancreas

Retroperitoneal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Position of the third part of the duodenum

A

Retroperitoneal, coursing between the SMA and the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

From where do the second and third portions of the duodenum receive their blood supply?

A

From the anteriosuperior and posterosuperior pancreaticoduodenal branches of the gastroduodenal artery and anterioinferior and posteroinferior pancreaticoduodenal branches of the superior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where does the fourth portion of the duodenum receive its blood supply?

A

First jejunal branch of the superior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an anatomic landmark for the transition between the duodenum and the jejunum?

A

The ligament of Treitz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is the small bowel differentiated?

A

By the valvulae conniventes, circular folds of mucosa and submucosa that markedly increase absorptive surface area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the difference between the jejunum and ileum?

A

The messenteric vessels of the jejunum form only one or two arterial arcades and send out long vasa recta
The ileum contains multiple arterial arcades that give off short vasa recta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

From where do the ileum and jejunum derive their blood supply?

A

From the superior mesenteric artery and venous drainage via the superior mesenteric vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the four layers of the bowel wall from inside to outside?

A

Mucosa
Submucosa
Muscularis
Serosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can the mucosa be further divided?

A

Muscularis
Lamina propria
Epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Muscularis

A

A thin layer of the muscle separating the mucosa from the submucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lamina propria

A

A continuous layer of connective tissue between the muscularis and epithelium, serves as a supportive base for the villi and a protective barrier against microorganisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is one type of cells residing in the lamina propria?

A

Cells of the immune system, including Peyer’s patches (aggregates of lymphoid tissue containing immune cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Epithelium

A

Villi and crypts of Lieberkuln

Functions as digestion, absorption, cell renewal, and secretion of hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the purpose of the submucosa?

A

Support and strength layer

Contains blood vessels, lymphatics and nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the muscularis (general layer)?

A

An inner circular and an outer longitudinal layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is sandwiched between the muscularis layers?

A

Ganglion cells that constitute the myenteric (Auerbach) plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the serosa composed of?

A

Flattened mesothelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How is pain mediated?
Through visceral afferent fibers of the sympathetic nervous system
26
Sympathetic innervation
3 sympathetic ganglia are located around the base of the superior mesenteric artery and control blood vessel tone and to a lesser extent gut secretory function and motility
27
Parasympathetic innervation
Parasympathetic nerve fibers are derived form the vagus nerve and primarily regulate gut secretory function and motility
28
What is one of the most common pathologic processes affecting the small bowel?
Obstruction
29
What are the most common causes of obstruction?
Adhesion (result of >60%) Hernias Tumors
30
What appear to be associated with a higher incidence of adhesive obstruction?
Lower abdominal and pelvic operations (appendectomy and adnexal procedures)
31
Labs for obstruction
``` Hypokalemic Hypochloremic Metabolic alkalosis Metabolic acidosis Hematocrit may be falsely elevated d/t volume depletion and anemia may indicate underlying malignancy ```
32
External hernias
Include those found in the inguinal canal, femoral canal, and in previous incisions
33
Internal hernias
Include those related to the inadequate closure of mesenteric defects created by prior operations, congenital mesenteric defects, and obturator foramen hernias
34
Imaging for obstruction
Upright chest, supine and upright abdominal X-ray
35
Imaging findings for obstruction
Dilated loops of bowel and air fluid levels, often with a step-like appearance
36
What may provide a therapeutic effect in some cases of SBO?
Oral contrast Gastrogradin (diatrizoic acid) is a hyperosmolar gastrointestinal water-soluble agent, which has been shown to speed the resolution of partial SBO and has also been shown to reduce hospital length of stay
37
Strangulation
Thickening of the bowel wall, pneumatosis instestinalis, ascites or mesenteric hematoma
38
Tx of SBO
Partial SBO- initially nonoperative -Defined as no or minimal sx in 3-5 days -Parenteral nutrition should be started -Pts who initially resolve a partial SBO but then recur need surgical exploration Pts with a complete SBO are at a high risk of strangulation
39
Surgical tx of SBO
Lysis of adhesions, resection of nonviable or diseased bowel with anastamosis or intestinal bypass One should palpate the root of the small bowel mesentery for a pulse in the SMA to be certain vascular compromise is not d/t occlusion of the SMA
40
How can bowel viability be further confirmed?
Fluorescein angiography | Doppler u/s
41
Fluorescein angiography in SBO
Hemogenous hyperfluorescence with a fine granular or reticular pattern suggests nl bowel, wheras patchy fluorescence or nonfluorescence suggests nonviable bowel
42
Doppler u/s in SBO
If nonviable bowel is identified during abdominal exploration, it should be resected and a "second-look" laparotomy 24-48 hrs after to reassess bowel viability
43
What are intraoperative techniques to decrease the formation of adhessions?
Moistening of the mesothelium Reduction of intra-abdominal foreign materials Irrigation to remove intra-abdominal blood and clot Use of sharp scalpel dissection as opposed to cautery Avoidance of unnecessary bowel manipulation
44
Agents to decrease adhesion rate
``` Intercede Gore-Tex Fibrin sheets Polyethylene glycol spray Hyaluronic acid gel Glucose peritoneal installates ```
45
Additional causes of SBO
Gallstone ileus Intussusception Volvulus Intestinal pseudo-obstruction
46
Gallstone ileus
The development of a cholecystoduodenal fistula with distal propagation of a gallstone
47
How common is a gallstone ileus?
Uncommon, but associated with considerable morbidity and mortality
48
Who is more likely to get a gallstone ileus?
Elderly In pts with severe concomitant dz In pt with gallstones 2-5 cm in diameter
49
Sx of gallstone ileus
Intestinal obstruction Pneumobilia Gallstone Change of position of a gallstone
50
Surgical intervention for a gallstone ileus
Laparotomy Enterotomy Removal of the stone
51
Intussusception
Leading edge or intussusception is usually in an intraluminal lesion
52
CT findings in intussusception
Intraluminal soft tissue "mass" with high attenuation peripherally and low attenuation centrally, known as "target sign"
53
Volvulus
The twisting of a loop of bowel around the axis of a long narrow mesentery, often associated with malrotation or internal herniation
54
What procedure should be done if there's viable bowel in a volvulus? If viable bowel and malrotation?
Enterolysis | Ladd procedure
55
Ladd procedure
Counterclockwise reduction of the volvulus, division of Lad bands/adhesions and appendectomy
56
What are Ladd bands?
Fibrous stalks or peritoneal tissue connecting the cecum to the abdominal wall, which creates the site of duodenal obstruction in malrotation
57
What is required with a volvulus if the bowel appears nonviable?
A Ladd procedure and bowel resection is required
58
Presentation of intestinal pseudo-obstruction
Mimics appendicitis Pt may have a hx of repeated surgical procedures in attempt to detect a mechanical cause of these sx Most commonly idiopathic but can be familial or associated with scleroderma, hypothyroidism, hypoparathyroidism or celiac dz
59
Surgical options for intestinal pseudo-obstruction
Enterostomy Bypass procedure Bowel resection
60
What is the most commonly involved site in Crohn's dz?
The terminal ileum
61
Who does Crohn's dz more commonly affect?
Smokers Ppl who reside in industrial areas Ashkenazi Jews
62
What may be found at the time of a Crohn's surgical exploration?
Bowel perforation Abscess formation Enterovisceral fistula
63
What may be present pathologically with Crohn's dz?
Areas of thick grayish-white exudate or fibrosis and extension of the mesenteric fat around the circumference of the bowel may be present + fibrosis + ulceration
64
Cobblestone appearance in Crohn's
Linear ulceration with surrounding mucosal and submucosal edema
65
60-70% of Crohn's pts may have...
Noncaseating granulomas with Langerhans giant cells
66
Clinical manifestations of Crohn's dz
``` Extraintestinal: Arthralgias Uveitis Erythema nodosum Pyoderma gangrenosum Arthritis Hepatitis Pericholangitis ```
67
Crohn's complications requiring surgery
``` Obstruction Perforation Fistula Abscess Perianal dz ```
68
What is the incidence of colonic malignancy in Crohn's?
6x greater than in the general population
69
Diagnostic findings in Crohn's dz
Granular, discrete, aphthous ulcerations surrounded by nl tissue and a cobblestone-like appearance of the mucosa, diffuse narrowing of bowel lumen, and asymmetric involvement of the bowel wall leading to nodular contour
70
Nutritional considerations in Crohn's
Protein-calorie malnutrition occurs in 80-90% of pts
71
What is the MC indication for operation in Crohn's?
Fistula
72
EC fistulas in Crohn's
Treated with resection of affected bowel and debridement of the fistula tract
73
Enteroenteric fistulas in Crohn's
May be left alone if asymptomatic; however if large segments are bypassed, significant malabsorption and fluid loss may ensure necessitating surgery.
74
Surgery for enterovesical and enteroadnexal fistulas in Crohn's
Involves resection of the affected bowel and fistula tract and closure of the bladder or adnexal defect
75
Obstruction in Crohn's
Healthy intervening segments of bowel flanked by diseased segments should only be resected if <5 cm If a short stricture is the cause of the obstruction, then strictureplasty (Heineke-Mikulicz type) can be performed making a longitudinal incision through the stricture and closing it in a transverse fashion
76
Contraindications to strictureplasty for Crohn's
Small bowel perforation Multiple strictures in a short segment Concern for malignancy
77
Prognosis of Crohn's
The most common site of recurrence is the small bowel, just proximal to the prior site of resection

Surgery (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions