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ABSITE > Small bowel > Flashcards

Small bowel Flashcards

1
Q

Steps to Witzel Jejunostomy

A

Midline incision
Loop of jejunum 20 distal to ligament of treitz
Pursestring suture
enterotomy
feeding tube place and purse string suture is tied
create 4-6cm serosal tunnel
3-0 silk interrupted Lembert sutures
Jejunum sutured to peritoneum
tube brought out through stab incision in abdominal wall
tube sutures in place midline is closed

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2
Q

MC primary source of metastatic disease to small bowel

A

Melanoma of Skin

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3
Q

MC cancer of small bowel

A

metastatic disease

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4
Q

MC primary cancer of small bowel

A

carcinoid

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5
Q

2nd MC primary cancer of small bowel

A

adenocarcinoma

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6
Q

Broad vs narrow base Meckel diverticulum

A

Narrow: <2cm -> diverticulectomy
Broad: >2cm -> segmental resection

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7
Q

Older male, Hx of CRC, 1cm sessile polyp in 1st portion of duo, Bx shows finger-like projections and dysplastic epithelium, what is Dx?

A

Small intestinal villous adenoma

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8
Q

Small intestinal villous adenoma

A 
sessile polyp
fingerlike projections & dysplastic epithelium on Bx
highest malignant potential (35-55%)
assoc w/ FAP
can be large (>5cm)
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9
Q

Brunner gland polyps

A

hyperplastic proliferation of Brunner gland ducts and stroma, in prox duodenum
no risk of malignant transformation
mimin PUD

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10
Q

Small bowel polyp biopsy findings concerning for malignancy

A

ulceration
severe dysplasia
pancreatic/CBD dilation

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11
Q

MC location of villous adenomas

A

duodenum

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12
Q

MC location of small bowel adenoma

A

ileum

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13
Q

MC extranodal site for NHL

A

GI tract

(stomach > SB > LB)

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14
Q

Lugano Staging System for GI Lymphoma

A

Stage I-E1: confined to mucosa or submucosa
Stage I-E2: Confined to muscularis propria or serosa
Stage II-E1: involvement of local nodes (para-gastric, para-intestinal)
Stage II-E2: Involvement of distal nodes (para-aortic, mesenteric)
Stage IV: disseminated extranodal involvement, supra-diaphragmatic nodal involvement

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15
Q

Carcinoid syndrome

A

intense facial flushing
severe diarrhea

primary small bowel tumor (carcinoid) with liver lesion (mets)

release of serotonin -> urinary 5-HIAA

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16
Q

Metabolic test of choice to dx carcinoid syndrome

A

urinary 5-HIAA
>25mg/d is diagnostic

chromogranin A (CgA) >95% sensitive for well-differentiated metastatic neuroendocrine tumors (can be falsely elevated w. PPI use)

17
Q

Imaging findings for SB neuroendocrine tumors

A

hyperenhancing small bowel mass, desmoplastic mesenteric reaction, tethering of adjacent small bowel, bulky adenopathy

liver mets: isodense with central necrosis

18
Q

Carcinoid syndrome treatment

A

Octreotide or Lanreotide (somatostatin analogs)

19
Q

GI Neuroendocrine tumors location

A

Appendix, distal ileum, colon, and rectum

20
Q

Cell origin of GI neuroendocrine tumors

A

enterochromaffin cells (aka: Kulchitsky cells)

21
Q

Pt w/ chronic abd pain, bloating, diarrhea, weight loss (think IBD/IBS), noted w/ small bowel mass.
Path: villous atrophy of adjacent jejunal mucosa

what is diagnosis?

A

enteropathy-associated T-cell lymphoma (EATL)

22
Q

Enteropathy-associated T-cell lymphoma

A

MC affects prox jejunum

Histo: circumferentially associated ulcers, assoc w/ perf. tumor cells invade the intestine wall, monotonous anaplastic clonal cells, express T-cell markers/recs, pale-staining cytoplasm, prominent nucleoli

Adjacent mucosa shows signs of celiac disease (villous atrophy, crypt hyperplasia, increased LCs and plasma cells in lamina propria)

Dx: bx for type and grade and to guide tx

tx: cyclophosphamide, doxorubicin, vincristine, prednisone; aggressive -> stem cell transplant; surgery for complications - perf, obstruction

23
Q

MC histo subtype of SB lymphomas

A

B-cell NHL (MALT, Diffuse large B-cell)

24
Q

MC site of Diffuse large B-cell lymphoma

A

terminal ileum (peyer’s patches - LN basins)

25
Q

Diffuse large b-cell lymphoma

A

Aggressive, large tumors

Responsive to chemo

26
Q

Small bowel hemangiomas

A

Rare benign tumors of SB
Present with occult GIB, IDA (but not a common cause of GIB due to rarity of diagnosis)
Operative management to control sxs -> endoscopic management is usually successful and first-line

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