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Small intestine > SI > Flashcards

SI Flashcards

1
Q

most frequently encountered surgical disorder of the SI

A

Mechanical small bowel obstruction

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2
Q

epidemiology of SBO

A
  1. intraabdominal adhesions
  2. hernia
  3. Chron’s dse
  4. neoplasms
  5. SMA syndrome, volvulus, intussussption, foreign bodies
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3
Q

signs of intestinal obstruction

A

Colicky abdominal pain, N/V, Abdominal distention, Obstipation, scar

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4
Q

Triad of SBO (xray)

A

dilated small bowel
air fluid levels
paucity of air in the colon

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5
Q

Xray positions in SBO

A

upright chest
upright abdomen
supine abdomen

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6
Q

Closed loop obstruction

A

U shape or C shape dilated bowel loops

radial distribution of mesenteric vessels -> torsion point

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7
Q

Strangulation (TPPMP)

A 
thickening of bowel walls
pneumatosis interstinalis
portal venous gas
mesenteric haziness
poor uptake of IV contrast
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8
Q

contrast used in SBO CT scan

A

oral water-soluble contrast

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9
Q

limitation of CT scan in SBO

A

low sensitivity (patrial small bowel obstr)

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10
Q

used in cases of partial small bowel obstruction

A

Small bowel series / enteroclysis

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11
Q

conservative management of SBO

A

IVF, antibiotics, bowel rest, NGT for decomperssion

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12
Q

Conditions treated with condservative therapy as initil tx

A

Partial obstruction
Complete obstruction
Carcinomatosis
Obstruction in early postop

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13
Q

what to check for viability in Surgery

A

normal color(pink)
peristalisis
marginal arterial pulsations

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14
Q

What to use when i doubt to check for pulsatile mass

A

doppler probe

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15
Q

what to use to verify arterial perfusion

A

IV fluorescein fye

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16
Q

which part of the SI is affected in Chron’s

A

Distal ileum

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17
Q

risk factors for Chron’s dse

A

smoking, female, high socioeconomic status, genetics

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18
Q

what gene increase risk for chron’s dse

A

NOD 2 on chromosome 16 / IBDI locus

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19
Q

what layer is affected in Chron’s

A

All layers

20
Q

leads to adhesion, strictures, fistulas and abscesses

A

serosal inflammation

21
Q

earliest lesion in Chroh’s

A

Aphthous ulcer, halo of erythema

coalace -> cobblestone appearance

22
Q

characteristic of chrohn’s

A

noncesating granuloma

23
Q

pathognomonic for chron’s

A

fat wrapping

24
Q

discontinuous portions of si

A

skip lesions

25
Q

Main diagnostic tool for Crohn’s

A

Colonoscopy

  • ulcerations
  • cobble stone with skip lesions
26
Q

crohn’s: ASCTA_ and pANCA _

Ulcerative colitis ASCA _ and PANCA _

A

C: +,-
U: -,+

27
Q

T/F. there is a cure for crohn’s

A

F. no cure so palliative cure

28
Q

Active dse in Crohn’s

A

Thickening fo bowel wall and mesentery
Narrowing of lumen
serosal inflammation and covered with fat

29
Q

procedure of choice for Crohn’s

A

Segmental resection with end to end anastonosis

30
Q

For short stricture (<12cm)

A

Heinecke-Mlikulicz

31
Q

for long stricture (25cm)

A

Finney

32
Q

T/F. Appendectomy is done even if appx is normal

A

True

33
Q

Definition of fistula

A

Abnormal connection or communication bet two epithelialized hollow surface or organs

34
Q

factors that hinder closure (Friends)

A 
Foreign body w/in tract
Radiation enteritis 
Inflammation/infection
Epithelialization 
Neoplasm
Distal obstruction of small bowel
SHort fistuolous tract
35
Q

most useful initial test for stable px

A

CT scan

36
Q

Small bowel series (3)

A

if CT scan failed to show fistula
site of origin of fistula
r/o distal intestinal obstruction

37
Q

most common benign neoplasm of the small intestine

A

Adenoma

  1. tubular (leat agg)
  2. tubulovillous
  3. villous- most aggressive
38
Q

most common mesenchymal tumor arising fro the small intestine

A

gastrointestinal stromal tumor

- interstitial cells of cajal

39
Q

most common extranodal form of lymphoma

A

primary GI lymphoma
- lymphocytes
ileum

40
Q

treatment of small bowel neoplasm

A

resection

41
Q

Therapies for adenoma

A

<1: endoscopically
>2, transduodenal polypectomy or segmental duodenal resection
2nd portion: pancrearicoduodenectomy/whiples

42
Q

induces cellular injury directly and thru generation of free radicals

A

radiation enteritis
- great impact on rapidly proliferating cells
-dose: 4500
Effects potentiated by chemotherapeutic drugs
- methotrexate, doxorubicin, 5-fluorocil,catinomycin D

43
Q

T/F. Chronic mucosa only, acute all layers

A

F.

44
Q

Acute radiation enteritis

A

mucosa only

villus blunting, leukocytes, plasma cells in crypt

45
Q

Chronic radiation enteritis

A

occlusion vasculutus
chronic ischemia
terminal ileum
diag: ELECTROLYSIS

46
Q

gold standard diagnostic of meckel’s diverticulum

A

Radionuclide scans (Tc-pertechnetate) scintigraphy

Small intestine (1 decks)

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