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ABSITE > Small Bowel > Flashcards

Small Bowel Flashcards

1
Q

Nutrient vs. Water absorption small vs. large bowel

A

Small bowel: Nutrient and water

Large: Water

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2
Q

The 4 portions of the duodenum

A

Bulb – 90% ulcers
Descending – ampulla/dcuts
Transverse – 3
Ascending – 4

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3
Q

Which portions of the duodenum are the acute angle between the aorta and SMA

A

3 and 4

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4
Q

Vascular supply of duodenum

A

GDA (Superior (A/P superior))/Pancreaticoduodenal (IMA)

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5
Q

Jejunum – T/F Maximum site of all absorption

A

100 cm long; long vasa recta, circular muscle folds. True

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6
Q

B12 is absorbed in…

A

TI

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7
Q

Bile acids are absorbed in …

A

Ileum, TI (conjugated)

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8
Q

Fe is absorbed in the …

A

Duodenum

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9
Q

Folate is absorbed in the …

A

TI

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10
Q

Does the ileum have long or short vasa recta

A

Short

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11
Q

95% of NaCl and 90% of water absorbed in the jujunum or ileum

A

Jejunum

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12
Q

Which is longer the jejunum or ileum

A

Ileum (150 vs 100 cm)

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13
Q

Name the different cell types in the small intestine

A 
Absorptive
Goblet: mucin
Paneth: secretory granules
Enterochromaffin (carcinoid)
Brunners; Peyers; M cells
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14
Q

Most important hormone in the migrating motor complex (which phase of gut motility?)

A 
Motilin --
I - rest
II - acceleration and GB contraction
III - peristalsis
IV - decel
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15
Q

95% of bile salts are re-absorbed

A

50% active resorption in TI (Na/K ATPase)

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16
Q

Why do gallstones form after TI resection

A

Malabsorption of bile salts

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17
Q

How is short gut diagnosed?

A

Symptoms, not length of bowel

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18
Q

Symptoms of short gut

A

Weight loss, steatorrhea, nutritional deficinency

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19
Q

How do you check for fecal fat?

A

Sudan red stain

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20
Q

What test do you use for B12 absorption

A

Schilling test

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21
Q

How much bowel do you need to survive off TPN / vs. with a competent ileocecal valve?

A

75cm to survive off TPN, 50cm with competent ileoceal valve

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22
Q

Treatment of short gut

A

Restrict fat, PPI, Lomotil

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23
Q

Causes of statorrhea

A

Gastric hypersecretion of acid, increased intestinal motility; interrpution of bile sale resorption (TI resection); decreased panc enzymes; weight loss / ADEK essential fatty acids

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24
Q

Causes of non-healing fistula

A

FRIENDS

Foreign body, radiation, IBD, epithelialization, neoplasm, distal obstruction, sepsis/infection

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25
Q

High output fistulas

A

More likely with proximal bowel (duodenum, proximal jejunum); less likely to close with conservative management

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26
Q

Which fistulas are more likely to close: colon or small bowel

A

Colon

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27
Q

Patients with a fistula and persistent fever

A

Abscess: fistulogram, CT, UGI with SBFT

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28
Q

Most fistulas are iatrogenic and treated conservatively first with…

A

NPO, TPN, stoma appliance, octreotide

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29
Q

Surgical options for fistula

A

Resect bowel segment containing fistula and perform primary anastamosis

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30
Q

MCC SBO in virgin/non-virgin abdomen

A

Virgin: SBO/Hernia, LBO/Cancer

Non-virgin: SBO/Adhesions, LBO/Cancer

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31
Q

Why do you see air with SBO

A

Swallowed nitrogen

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32
Q

What percentage of partial vs full SBO are cured by conservative management

A

80% vs 40%

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33
Q

Surgical indication for SBO

A

Progressive pain, peritonitis, fever, leukocytosis, failure to resolve

34
Q

A gallstone ileus is caused by…

A

Fistula between gallbladder and duodenum second part

35
Q

Meckel’s diverticulum is caused by…

A

Failure of closure of omphalomesenteric duct to close

36
Q

50% of painless lower GI bleeds in children < 2 years old

A

Meckel’s

37
Q

Most common tissue found in Meckel’s

A

Pancreatic; however gastric can cause symptoms

38
Q

Management of duodenal diverticula

A

Rule out gallbladder-duodenal fistula; observe unless perforated, bleeding, obstructive, symptomatic
(D>J>I)

39
Q

Extra-intestinal manifestations of Crohn’s

A

Arthritis, arthralgia, pyoderma, ocular, growth failure, megaloblastic anemia B12/folate

40
Q

Rectal sparing in Crohn’s

A

True

41
Q

Most commonly involved bowel segment in Crohn’s

A

TI

42
Q

Crohn’s vs. UC

A

Transmural inflammation, skip lesions, cobblestoning, deep ulcers, creeping fat

43
Q

Meds for Crohn’s

A

Remicade (infliximab) Sulfasalazine, loperamide, steroids; Flagyl; TPN

44
Q

What percentage of Crohn’s patients evenutally need an operation

A

90%

45
Q

Do you perform lateral sphincteroplasty in patients with Crohn’s disease?

A

No

46
Q

Can you do a pouch or ilio-anal anastamosis for patients with Crohn’s disease?

A

No

47
Q

Serotonin is produced by…

A

Kulchitsky cells – enterochromaffin cell or argentaffin cell
5-HIAA is a breakdown product of serotonin

48
Q

Carcinoid syndrome

A

Liver mets: flushing, diarrhea
Asthma-like, R heart valve lesions
(Liver usually clears serotonin(

49
Q

Octreotide scan

A

Used for carcinoid

50
Q

Most common site for carcinoid

A

Appendix

51
Q

Appendiceal carcinoid treatment

A

< 2 cm: appy

> 2 cm: R hemi

52
Q

CTX for carcinoid

A

Strptozocin, 50FU

Octreotide; palliation

53
Q

Treatment for salmonella enteritis

A

Bactrim

* RLQ, diarrhea, fever, HA, mac pap rash, leukopenia, bleeding/perf

54
Q

In a child – * RLQ, diarrhea, fever, HA, mac pap rash, leukopenia, bleeding/perf rare

A

Salmonella typhoid enteritis

55
Q

MCC electrolyte abnormality a/w ileus

A

K

56
Q

MCC death in appendix mucocele

A

Malignant small bowel obstruction

57
Q

T/F Regional ileitis can mimic appendicitis

A

True; 10% go on to develop Crohn’s

58
Q

Should you open for an appendix mucocele?

A

Yes; rupture –> pseudomyxoma peritonei

59
Q

MCC acute abdominal pain in 1st trimester

A

Appendicitis

60
Q

What trimester is acute appendicitis most likely?

A

Second

61
Q

When is acute appendicitis most likely to perforate in pregnancy?

A

Third trimester

62
Q

Is the appendix displaced cephalad during pregnancy?

A

Yes

63
Q

What percentage of fetal death with ruptured appendicitis in pregnancy?

A

35%

64
Q

Women with suspected appendicitis should always have…

A

b-HCG and abdominal ultrasound to r/o pregnancy

65
Q

What is the general sequence of symptoms a/w acute appendicitis

A

1st: Anorexia
2nd: Peri-umb abdominal pain
3rd: Vomiting

66
Q

What does a CT scan show in acute appendicitis?

A

Diameter > 7 mm; Wall thickness > 2mm; no contrast in lumen

67
Q

Most likely location of perforation of appendicitis

A

Midpoint of anti-meseneric border

68
Q

Most common cause of acute appendicitis in children

A

Lymphoid hyperplasia; can follow a viral illness

69
Q

Most common cause of acute appendicitis in adults

A

Fecalith

70
Q

What is the pathophysiology of ruptured appendicitis?

A

Luminal obstruction, distension of appendix, venous congestion and thrombosis, ischemia, gangrene, rupture

71
Q

Treatment of ruptured appendicitis

A

Perc drainage and interval appendectomy – need to r/o perforated cecal cancer

72
Q

Do you need to repair a parastomal hernia?

A

No – unless symptomatic

73
Q

Most common stomal infection

A

Candida

74
Q

What is diversion colitis?

A

Secondary to lack of SCFA’s – treatment is SCFA enemas

75
Q

Most common cause of stoma stenosis

A

Ischemia; dilate if mild

76
Q

Most common cause of fistula near stoma site

A

Crohn’s

77
Q

Are gallstones more common in patients with ileostomy

A

Yes – loss of bile salts

78
Q

Are uric acid stones more likely in patients with ileostomy?

A

Yes; loss of bicarb

79
Q

Where are most small bowel adenomas found?

A

Duodenum; can p/w bleeding, obstruction; need resection when identified

80
Q

Is Peutz-Jeghers syndrome AD or AR?

A

AD: hamartomas throughout GT tract (small and large bowel); mucocutaneous melanotic skin pigmentation; patients have increased extra-intestinal malignancies,; MC – breast cancer, small risk of Gi malignancies

81
Q

Do patients with Peutz-Jeghers get prophylactic colectomy?

A

No

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