SI Flashcards
most frequently encountered surgical disorder of the SI
Mechanical small bowel obstruction
epidemiology of SBO
- intraabdominal adhesions
- hernia
- Chron’s dse
- neoplasms
- SMA syndrome, volvulus, intussussption, foreign bodies
signs of intestinal obstruction
Colicky abdominal pain, N/V, Abdominal distention, Obstipation, scar
Triad of SBO (xray)
dilated small bowel
air fluid levels
paucity of air in the colon
Xray positions in SBO
upright chest
upright abdomen
supine abdomen
Closed loop obstruction
U shape or C shape dilated bowel loops
radial distribution of mesenteric vessels -> torsion point
Strangulation (TPPMP)
thickening of bowel walls pneumatosis interstinalis portal venous gas mesenteric haziness poor uptake of IV contrast
contrast used in SBO CT scan
oral water-soluble contrast
limitation of CT scan in SBO
low sensitivity (patrial small bowel obstr)
used in cases of partial small bowel obstruction
Small bowel series / enteroclysis
conservative management of SBO
IVF, antibiotics, bowel rest, NGT for decomperssion
Conditions treated with condservative therapy as initil tx
Partial obstruction
Complete obstruction
Carcinomatosis
Obstruction in early postop
what to check for viability in Surgery
normal color(pink)
peristalisis
marginal arterial pulsations
What to use when i doubt to check for pulsatile mass
doppler probe
what to use to verify arterial perfusion
IV fluorescein fye
which part of the SI is affected in Chron’s
Distal ileum
risk factors for Chron’s dse
smoking, female, high socioeconomic status, genetics
what gene increase risk for chron’s dse
NOD 2 on chromosome 16 / IBDI locus
what layer is affected in Chron’s
All layers
leads to adhesion, strictures, fistulas and abscesses
serosal inflammation
earliest lesion in Chroh’s
Aphthous ulcer, halo of erythema
coalace -> cobblestone appearance
characteristic of chrohn’s
noncesating granuloma
pathognomonic for chron’s
fat wrapping
discontinuous portions of si
skip lesions
Main diagnostic tool for Crohn’s
Colonoscopy
- ulcerations
- cobble stone with skip lesions
crohn’s: ASCTA_ and pANCA _
Ulcerative colitis ASCA _ and PANCA _
C: +,-
U: -,+
T/F. there is a cure for crohn’s
F. no cure so palliative cure
Active dse in Crohn’s
Thickening fo bowel wall and mesentery
Narrowing of lumen
serosal inflammation and covered with fat
procedure of choice for Crohn’s
Segmental resection with end to end anastonosis
For short stricture (<12cm)
Heinecke-Mlikulicz
for long stricture (25cm)
Finney
T/F. Appendectomy is done even if appx is normal
True
Definition of fistula
Abnormal connection or communication bet two epithelialized hollow surface or organs
factors that hinder closure (Friends)
Foreign body w/in tract Radiation enteritis Inflammation/infection Epithelialization Neoplasm Distal obstruction of small bowel SHort fistuolous tract
most useful initial test for stable px
CT scan
Small bowel series (3)
if CT scan failed to show fistula
site of origin of fistula
r/o distal intestinal obstruction
most common benign neoplasm of the small intestine
Adenoma
- tubular (leat agg)
- tubulovillous
- villous- most aggressive
most common mesenchymal tumor arising fro the small intestine
gastrointestinal stromal tumor
- interstitial cells of cajal
most common extranodal form of lymphoma
primary GI lymphoma
- lymphocytes
ileum
treatment of small bowel neoplasm
resection
Therapies for adenoma
<1: endoscopically
>2, transduodenal polypectomy or segmental duodenal resection
2nd portion: pancrearicoduodenectomy/whiples
induces cellular injury directly and thru generation of free radicals
radiation enteritis
- great impact on rapidly proliferating cells
-dose: 4500
Effects potentiated by chemotherapeutic drugs
- methotrexate, doxorubicin, 5-fluorocil,catinomycin D
T/F. Chronic mucosa only, acute all layers
F.
Acute radiation enteritis
mucosa only
villus blunting, leukocytes, plasma cells in crypt
Chronic radiation enteritis
occlusion vasculutus
chronic ischemia
terminal ileum
diag: ELECTROLYSIS
gold standard diagnostic of meckel’s diverticulum
Radionuclide scans (Tc-pertechnetate) scintigraphy
