Small bowel Flashcards
Staging GI lymphoma
Lugano Staging System
IE1 - mucosa/submucosa
IE2 - muscular propria/serosa
IIE1 - local nodes
IIE2 - distant nodes (para-aortic, mesenteric)
IV - Disseminated extranodal above and below diaphragm
Types of small bowel adenomas and highest risk
Villous, true and Brunners
Villous highest risk 35-55% malignancy
Hx of FAP with multiple duodenal polyps; tx
Pancreaticoduodenectomy
EGD surveillance with hx of FAP
1-3yrs
Most common small bowel malignancy; tx
Metastatic, surgical resection
Difference between Crohn’s and UC
Crohn’s originates at the TI, transmural and skips
UC originates rectum and is continguous
Chronic pancreatitis effect on absorption
Loss of digestive enzymes like lipase which help absorb long-chain fatty acids
Short bowel syndrome
<200cm
Key elements to small bowel anastomosis
Watertight, submucosa for strength, tension free
High output ileostomy electrolyte abnormality
Hyponatremic, hypokalemic, normal AG metabolic acidosis
S/p gastroschisis repair with bowel resection; next step
ICU on TPN and fluid/electrolyte managment
Pneumatosis intestinalis unstable, next step
OR for ex lap
Direction of anastomosis with side to side
Anastomose antimesenteric border of both loops
Most common cause of small bowel hemorrhage
Angiodysplasia
Index screening for colon cancer in patient with UC
Within 8 years of diagnosis and every 1-3yrs after
Most common cause for small bowel obstruction
Adhesions
Small bowel lymphoma tx
Wide surgical resection with LND if possible + chemorads
Best diagnostic test for SBO
CT
Best loop ileostomy technique
Distal as possible, 10-15cm from IC valve
Management 3cm or less duodenal perf
Simple closure +/- Graham patch
Management >3cm duodenal perf unstable
Controlled duodenal fistula, pyloric exclusion, GJ
Macular mucosal hyperpigmentation and hamartomatous polyps; dx and complication
Peutz-Jegher, intussusception
Lowest risk of wound infection closing ostomy
Purse-string closure
Where do carcinoids originate
Enterochromaffin-like cells, Kulchitsky cells
Meckel’s rule of 2s
2%
2:1 males
2 ft from IC
2 inches
2 types gastric>panc
2 yrs
Normal appendix with meckel’s on ex laparoscopy; next step
Resect Meckel’s and appendix
Short segment strictureplasty; name, size, describe
Heineke-Mikulikz, up to 5-7cm, longitudinal incision with transverse closure
10cm strictureplasty; name, size, describe
Finney, up to 15cm, U shape
17cm strictureplasty; name, size, describe
Jaboulay, up to 20cm, side to side isoperistaltic
Small bowel adenocarcinoma; tx
Segmental resection and lymphadenectomy
Hx Crohn’s low-output converts to high-output after diet; next step
NPO + TPN
Hx Crohn’s with EC fistula with steatorrhea, diarrhea, megaloblastic anemia and malnutrition; dx
Blind Loop Syndrome,
Facial flushing and diarrhea with abdominal tumor; likely dx, next step, tx
Carcinoid tumor, Urine 5-HIAA, symptom control with ocreotide/lanreotide (somatostatin analogs)
Medically refractory fulminant C diff; tx
Total abdominal colectomy with end ileostomy
Define toxic megacolon
Colonic dilation >6cm and signs of systemic toxicity
Define fulminant C diff
Medically refractory hypotension and megacolon
Indication for endoscopic removal of duodenal adenoma
<2-3cm
<2cm intraductal growth
Modified Spigelman stage II or lower
Responsible for regulating migrating motor complexes
Motilin
Stimulates gastric acid and pepsinogen secretion
Gastrin
