Small Bowel 3 Flashcards
Causes of Meckel’s diverticulum?
failure of closure of omphalomesenteric duct (vitelline)
Two types of tissue seen in Meckels?
gastric
pancreatic
When do we perform a diverticulectomy in someone with a Meckels?
if base < 2 cm
if base > 2 cm, segmental resection of involved small intestine
***appendectomy should also be performed
Most common cause of intussusception in children?
lymphoid hyperplasia
We can reduce intussusceptions in children with air or water enemas in most cases, why?
most intussusception in kids is caused by lymphoid hyperplasia
Mainstay of treatment for T-cell lymphoma of small bowel?
chemo
**often present late
Primary fuel source for enterocytes vs colonocytes?
enterocytes–> glutamine
colonocytes–> short chain fatty acids
Pt’s with Crohn’s dx have a 10-12 fold increase risk of developing what type of Ca?
small bowel adenocarcinoma
mostly in ileum
Most common benign primary neoplasm of spleen?
hemangioma
What do we do with hemangiomas of the spleen?
typically asymptomatic
massive hamangiomas have risk of rupture (partial vs complete splenectomy recommended if rupture, capsular distention, pain)
Small bowel hemangiomas are rare benign small bowel tumors that present as occult GI bleeding, how do we commonly manage them?
endoscopically
Two mechanisms by which radiation therapy causes damage?
direct DNA damage
formation of oxygen free radicals
Describe luminal involvement in Crohn’s dx vs UC:
Crohns–> transmural involvement
UC–> mucosa only
Neutrophil infiltration of Crypts of Lieberkuhn is seen in?
UC
Carcinoids most commonly occur in appendix, followed by small bowel,what symptom do their present with if located in small bowel?
typically asymptomatic
most common presenting symptom is abd pain
Most common causes of SBO?
adhesions
hernias
neoplasms
Why do we tend to see small bowel lymphoma more commonly in terminal ileum?
peyer’s patches located in ileum
40% survival at 5 years
Where do we find the superior mesenteric artery during an ex-lap?
at the level of ligament of treitz
For treatment of a SMA embolism, how do we proceed surgically?
identify SMA at level of ligament of treitz
perform tranverse arteriotomy and then Fogarty balloon
Classify fistulas based on output:
Low <200 cc/day
moderate 200-500 cc/day
High >500 cc/day
After abdominal surgery how long does it take for small bowel, stomach, colon to regain their function?
small bowel 24 hrs
stomach 3 days
colon 5 days
How do we locate the SMA during surgery?
cephalad traction on tranverse colon
What causes wandering spleen, ectopic spleen?
extreme ligamentous laxity
absence of normal ligamentous attachments of spleen to lateral abdominal wall
Treatment for wandering spleen?
splenopexy–> attach it to its regular LUQ position
Pts with wandering spleen are at greatest risk for what?
torsion of splenic pedicle and infarction
Gastrointestinal and pulmonary theories regarding cause of pneumatosis intestinalis?
GI–> intra luminal air is forced into bowel wall by increased intra-abdominal air from chronic coughing in pts w/COPD
Resp–> alveoli rupture and dissect into the vasculature and tract thru the retroperitoneum into bowel mesentery
