Small Bowel

Question 1

Within 10 years how many crohns patients need surgery?

Answer 1

half

Question 2

2 initial long term Crohns meds?

What can be used for severe disease that has failed the above treatment?

Acute flare meds?

Answer 2

Mesalamine (5 aminosalicylate)
Budesonide

Humira(Adalimumab)

Steroids

Question 3

What part of the bowel is crohns most often found

Answer 3

TI

Question 4

Steps to dealing with stable patient with Crohn’s abscess

Answer 4

drain then +- resection

Question 5

3 indications for Crohn’s surgery

Answer 5

Some fistulas
Complete obstruction
Inflammatory masses

Question 6

Preop considerations for Crohn’s patients

Answer 6

Stoma? (steroids)
bowel prep, abx
nutritionist
time of biologics – 8weeks

Question 7

20-30% of crohn’s surgery can be this type

Answer 7

stricturoplasty

Question 8

What is the smallest form of stricturoplasty?

what is the next size up and what are the dimensions

Answer 8

Heineke —–longitudinal incision

Finney — 10-15cm

Question 9

4 indications for stricturoplasty

5 CXR

Answer 9

more than 100 cm sb resected prior surgery
Diffuse SB involved
Rapid recurrence
obstructing fibrosis

Pathologic features
Albumin<2
Perforation associated with stricture
Close to resection site
phlegmons and fistulas

Question 10

SB tumors account for __% of all GI tumors

Answer 10

3

Question 11

Reason for delay in SB tumor dg? How long on average

Answer 11

vague s/s; 30 wks

Question 12

5 genetic syndromes assoc wityh SB malignancy

Answer 12

FAP, HNPCC, peutz jegher, celiac, crohns

Question 13

4 cxr for pill cam

Answer 13

motility disorder
Crohns stricture
abdominal operation
Radiation

Question 14

Imaging for sb tumor

Answer 14

CT enterography or enteroclysis

Question 15

syndrome assoc with duodenal adenomas specifically

4 concerning features

Answer 15

FAP

> 1cm, villous, >20 polyps, severe dysplasia

Question 16

4 malignant small bowel tumors in order of frequency

Answer 16

NETS
Adeno
Lymphoma
GIST

Question 17

Another name for SB NETS?

What can happen with metastasis?

Answer 17

Carcinoid

Carcinoid syndrome

Question 18

NETS derive from….

Answer 18

epithelial cells from ECLCs

Question 19

SB NETS associated with these 2 genetic ssyndromes

Answer 19

MEN1(gastrinoma)
NF1(SS)

Question 20

Gastrinoma leads to this syndrome

Somatostatinoma leads to these 2 comorbids

Answer 20

ZES

cholelithiasis, DM

Question 21

Markers for SB NETS

Answer 21

chromogranin A
Urine 5 HIAA

Question 22

___ used to be the scan of choice for NET now its _____

Answer 22

octreotide; PET Dotatate

Question 23

% resectable disease on dg of SB malignancy

Answer 23

20

Question 24

Criteria for management of duodenal NET

Answer 24

<1cm: Endo
1-2cm open enucleation
>2 cm: full resection(possible whipple) + LNs

Question 25

When should cholecystectomy be done with associated NET

Answer 25

If octreotide therapy expected

Question 26

What should be given prior to induction for NET surgery if concerned for Carcinoid syndrome

Answer 26

Octreotide

Question 27

Criteria for surgical resection of NET mets

Answer 27

LIVER: resectable and well diff; no extra abdominal or diffuse peritoneal; no Right heart failure

Question 28

3 NET grades with 2 differentiating characteristics

Answer 28

Ki 67: 3 3-20 >20 Diff: well well poor