Small Bowel

Question 1

MC long term complication of ileal pouch anal anastomosis for UC?

Answer 1

Pouchitis

Question 2

Tensile strength of the small bowel is from what layer?

Answer 2

Submucosa; contains collagen

Question 3

Tx for small bowel lymphoma?

Answer 3

R-CHOP

Question 4

Small bowel GISTs:

Answer 4

Smoothly contoured submucosa mass

Typically in jejunum

Arise from interstitial cells of Cajal

Assc w/ defect in c-kit proto-oncogene

Question 5

How to diagnose suspected small bowel lymphomas?

Answer 5

Endoscopic bx of submucosa for proximal lesions

CT guided biopsy of distal lesions

Question 6

Staging for NHL?

Answer 6

Lugano classification

Stage II: more than one site, same side of diaphragm
Stage III: multiple sites above and below diaphragm
Stage IV: disseminated

Question 7

Gram positive bacillus;

Answer 7

C. Diff

Question 8

Meckels diverticulum is pts >50 y/o?

Answer 8

Do not remove unless you palpate an abnormality

There is a higher surgical morbidity and mortality with diverticulectomy in pts >50

Question 9

What part of small intestine do we commonly see carcinoids?

Answer 9

Ileum

Question 10

Common locations of carcinoids in the GI tract?

Answer 10

Rectum most common
Ileum
Appendix

Question 11

MC malignancy of small bowel?

Answer 11

Carcinoid; found in ileum

Arises from enterochromaffin cells (Kulchitsky cells)

Question 12

1 fuel source for enterocytes?

Answer 12

Glutamine

Question 13

1 fuel source for colon?

Answer 13

Short chain fatty acids

Question 14

Common locations of carcinoid tumors:

Answer 14

Rectum 1

Small intestine (ileum) 2

Appendix 3

Question 15

Types of strictureoplasty”

Answer 15

H-mickulicz; for <10 cm short segment narrowing

Finney or Jaboulay; for 10-20 cm strictures

Michelassi (side to side iso-peristaltic strictures); >20 cm

Question 16

Where are most proteins absorbed in the small bowel?

Answer 16

80-90% are absorbed in the duodenum/jejunum

If you resect ileum, it will have little effect on absorption of protein

Question 17

Enteropathy associated T-cell lymphoma?

Answer 17

Seen in setting of celiac disease