Small Bowel Flashcards
Within 10 years how many crohns patients need surgery?
half
2 initial long term Crohns meds?
What can be used for severe disease that has failed the above treatment?
Acute flare meds?
Mesalamine (5 aminosalicylate)
Budesonide
Humira(Adalimumab)
Steroids
What part of the bowel is crohns most often found
TI
Steps to dealing with stable patient with Crohn’s abscess
drain then +- resection
3 indications for Crohn’s surgery
Some fistulas
Complete obstruction
Inflammatory masses
Preop considerations for Crohn’s patients
Stoma? (steroids)
bowel prep, abx
nutritionist
time of biologics – 8weeks
20-30% of crohn’s surgery can be this type
stricturoplasty
What is the smallest form of stricturoplasty?
what is the next size up and what are the dimensions
Heineke —–longitudinal incision
Finney — 10-15cm
4 indications for stricturoplasty
5 CXR
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
SB tumors account for __% of all GI tumors
3
Reason for delay in SB tumor dg? How long on average
vague s/s; 30 wks
5 genetic syndromes assoc wityh SB malignancy
FAP, HNPCC, peutz jegher, celiac, crohns
4 cxr for pill cam
motility disorder
Crohns stricture
abdominal operation
Radiation
Imaging for sb tumor
CT enterography or enteroclysis
syndrome assoc with duodenal adenomas specifically
4 concerning features
FAP
> 1cm, villous, >20 polyps, severe dysplasia
4 malignant small bowel tumors in order of frequency
NETS
Adeno
Lymphoma
GIST
Another name for SB NETS?
What can happen with metastasis?
Carcinoid
Carcinoid syndrome
NETS derive from….
epithelial cells from ECLCs
SB NETS associated with these 2 genetic ssyndromes
MEN1(gastrinoma)
NF1(SS)
Gastrinoma leads to this syndrome
Somatostatinoma leads to these 2 comorbids
ZES
cholelithiasis, DM
Markers for SB NETS
chromogranin A
Urine 5 HIAA
___ used to be the scan of choice for NET now its _____
octreotide; PET Dotatate
% resectable disease on dg of SB malignancy
20
Criteria for management of duodenal NET
<1cm: Endo
1-2cm open enucleation
>2 cm: full resection(possible whipple) + LNs
When should cholecystectomy be done with associated NET
If octreotide therapy expected
What should be given prior to induction for NET surgery if concerned for Carcinoid syndrome
Octreotide
Criteria for surgical resection of NET mets
LIVER: resectable and well diff; no extra abdominal or diffuse peritoneal; no Right heart failure
3 NET grades with 2 differentiating characteristics
Ki 67: 3 3-20 >20
Diff: well well poor
