Small Bowel

Question 1

Lugano Staging for GI. Lymphoma

Answer 1

IE1 - M or SM
Ie2- MP or serosa
IIE1 para gastric node involvement
IIE2 distal nodes - para aortic nodes
IV disseminated across diaphragm

Question 2

Contraindications to Strictuoplasty

Answer 2

intrabdominal sepsis
Fistulae
Excessively long strictures
Hemorrhage
malignancy

Question 3

Witzel jejunostomy

Answer 3

Midline incision
loop 20 cm dital to LOT selected
Purse string and enterotomy created 
Feeding tube placed and pursestring is tied
Serosal tunnell for 4-6 cm with Lembert sutures
Jejunum sutured tothe peritoneum
Then stab incision
Tube sutured and midline closed

Question 4

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK543792%2Ffigure%2Fch13.Fig10%2F&psig=AOvVaw0nr0Mrn0DYjirPS6AkxEfa&ust=1633313165793000&source=images&cd=vfe&ved=0CAsQjRxqFwoTCNjE2deTrfMCFQAAAAAdAAAAABAD

Answer 4

closed loop bowel obstruction = ex lap

Question 5

1 dose ancef then watery diarrhea… what type of bug?

Answer 5

Gram Pos Bacili AKA C diff (even after 1 dose!)

Question 6

Priniciples of Loop Ileostomy

Answer 6

1. most distal ileum as possible to preserve SB absorption,
2. 10-15 cn from ICV for loop reversal
3. Divide rectus bluntly
   4.

Question 7

Acute appy suspected but Meckels found intra op

Answer 7

Diverticlectomy when the base is < 2 cm and segmental resection when >2cm.
**Appendectomy should also be perfomed

Question 8

___ is the MC primary sources for metastasis to the small bowel

Answer 8

Melanoma

Question 9

_ is the primary fuel source for SB enterocytes, while _ are the fuel source for colonocytes

Answer 9

Glutamine for SB and SCFA are for colon

Question 10

ERCP
CBD is at 11 o’clock
ampulla is at the 12 oclock position
PD 1 oclocl position

Answer 10

ERCP needs side viewing endoscope

Question 11

end ileostomy matured using __ technique

Answer 11

Brooke; involves eversion of the bowel to expose the mucosa followed by mucocutaneous suturing

Question 12

MC vit def of Crohn dz

Answer 12

B12 enterohepatic cycle from the distal ileum

Folate, C, D and K

Question 13

what is blind loop syndrome? and how to Dx it?

Answer 13

blind loop syndrome is a condition that occurs after gastric surgery (BII or Roux en Y), creates a blind loop that can lead to stagnant succus and bacterial overgrowth. Leads to bloating, def B12 and fat Malays.

Dx: carbohydrate breath test

Question 14

35 M with RLQ pain/fever/chills dx appendicitis, goes for lap happy.
Appendix normal but TI inflamed.
How to proceed?

Answer 14

Remove appendix (usually microscopic changes) and explore abdomen to work up Crohn’s