Small bowel

Question 1

Staging GI lymphoma

Answer 1

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

Question 2

Types of small bowel adenomas and highest risk

Answer 2

Villous, true and Brunners
Villous highest risk 35-55% malignancy

Question 3

Hx of FAP with multiple duodenal polyps; tx

Answer 3

Pancreaticoduodenectomy

Question 4

EGD surveillance with hx of FAP

Answer 4

1-3yrs

Question 5

Most common small bowel malignancy; tx

Answer 5

Metastatic, surgical resection

Question 6

Difference between Crohn’s and UC

Answer 6

Crohn’s originates at the TI, transmural and skips
UC originates rectum and is continguous

Question 7

Chronic pancreatitis effect on absorption

Answer 7

Loss of digestive enzymes like lipase which help absorb long-chain fatty acids

Question 8

Short bowel syndrome

Answer 8

<200cm

Question 9

Key elements to small bowel anastomosis

Answer 9

Watertight, submucosa for strength, tension free

Question 10

High output ileostomy electrolyte abnormality

Answer 10

Hyponatremic, hypokalemic, normal AG metabolic acidosis

Question 11

S/p gastroschisis repair with bowel resection; next step

Answer 11

ICU on TPN and fluid/electrolyte managment

Question 12

Pneumatosis intestinalis unstable, next step

Answer 12

OR for ex lap

Question 13

Direction of anastomosis with side to side

Answer 13

Anastomose antimesenteric border of both loops

Question 14

Most common cause of small bowel hemorrhage

Answer 14

Angiodysplasia

Question 15

Index screening for colon cancer in patient with UC

Answer 15

Within 8 years of diagnosis and every 1-3yrs after

Question 16

Most common cause for small bowel obstruction

Answer 16

Adhesions

Question 17

Small bowel lymphoma tx

Answer 17

Wide surgical resection with LND if possible + chemorads

Question 18

Best diagnostic test for SBO

Answer 18

CT

Question 19

Best loop ileostomy technique

Answer 19

Distal as possible, 10-15cm from IC valve

Question 20

Management 3cm or less duodenal perf

Answer 20

Simple closure +/- Graham patch

Question 21

Management >3cm duodenal perf unstable

Answer 21

Controlled duodenal fistula, pyloric exclusion, GJ

Question 22

Macular mucosal hyperpigmentation and hamartomatous polyps; dx and complication

Answer 22

Peutz-Jegher, intussusception

Question 23

Lowest risk of wound infection closing ostomy

Answer 23

Purse-string closure

Question 24

Where do carcinoids originate

Answer 24

Enterochromaffin-like cells, Kulchitsky cells

Question 25

Meckel’s rule of 2s

Answer 25

2%
2:1 males
2 ft from IC
2 inches
2 types gastric>panc
2 yrs

Question 26

Normal appendix with meckel’s on ex laparoscopy; next step

Answer 26

Resect Meckel’s and appendix

Question 27

Short segment strictureplasty; name, size, describe

Answer 27

Heineke-Mikulikz, up to 5-7cm, longitudinal incision with transverse closure

Question 28

10cm strictureplasty; name, size, describe

Answer 28

Finney, up to 15cm, U shape

Question 29

17cm strictureplasty; name, size, describe

Answer 29

Jaboulay, up to 20cm, side to side isoperistaltic

Question 30

Small bowel adenocarcinoma; tx

Answer 30

Segmental resection and lymphadenectomy

Question 31

Hx Crohn’s low-output converts to high-output after diet; next step

Answer 31

NPO + TPN

Question 32

Hx Crohn’s with EC fistula with steatorrhea, diarrhea, megaloblastic anemia and malnutrition; dx

Answer 32

Blind Loop Syndrome,

Question 33

Facial flushing and diarrhea with abdominal tumor; likely dx, next step, tx

Answer 33

Carcinoid tumor, Urine 5-HIAA, symptom control with ocreotide/lanreotide (somatostatin analogs)

Question 34

Medically refractory fulminant C diff; tx

Answer 34

Total abdominal colectomy with end ileostomy

Question 35

Define toxic megacolon

Answer 35

Colonic dilation >6cm and signs of systemic toxicity

Question 36

Define fulminant C diff

Answer 36

Medically refractory hypotension and megacolon

Question 37

Indication for endoscopic removal of duodenal adenoma

Answer 37

<2-3cm
<2cm intraductal growth
Modified Spigelman stage II or lower

Question 38

Responsible for regulating migrating motor complexes

Answer 38

Motilin

Question 39

Stimulates gastric acid and pepsinogen secretion

Answer 39

Gastrin