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*OldSurgery > Small Bowel Disorders > Flashcards

Small Bowel Disorders Flashcards

1
Q

what does the mesentery of the small bowel contain?

A

blood supply

lymphatics of the bowel

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2
Q

what is the most common cause of small bowel obstructions?

A

postoperative adhesions then neoplasms and hernias

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3
Q

what does Intusussception look like on CT?

A

target, bullseye

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4
Q

what do you call not passing gas or stool

A

obstipation

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5
Q

passing gas but not stool

A

constipation

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6
Q

time where someone has a SBO but no distention

A

if it is really proximal

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7
Q

SBO presentation

A

HPOTN, tachy, fever (septic)
sunken eyes, skin tenting, dry oral mucosa
abdominal distention
hernias, altered bowel sounds

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8
Q

what will bowel sounds be like with an early SBO?

A

hyperactive

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9
Q

what will bowel sounds be like with a late SBO?

A

hypoactive

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10
Q

what do peritoneal signs w/ a SBO indicate?

A

strangulation (need emergency surgery)

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11
Q

what does occult blood on a rectal w/ SBO suggect?

A

late strangulation or malignancy

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12
Q

mass on rectal exam w/ SBO suggests what?

A

obturator hernia

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13
Q

for a SBO what type imaging do you want?

A

three way of the abdomen

upright chest w/ supine and upright abdomen

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14
Q

on CTabd/ pelvis (IV oral and contrast) what represents an SBO

A

Obstruction is present if the small-bowel loop is greater than 2.5 cm in diameter dilated proximal to a distinct transition zone of collapsed bowel less than 1 cm in diameter

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15
Q

what indicates strangulation on a CT abd/ pelvis

A

bowel wall thickening
portal venous gas
pneumatosis

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16
Q

air within the bowel wall

A

pneumoatisis

indicates some necrosis may be going on

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17
Q

what Factors indicating higher risk of strangulation

A

Localized abdominal tenderness
Peritoneal signs
Fever or leukocytosis

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18
Q

what are signs of complete obstruction

A

no stool or flatus for 12 hours

no air in rectum on imaging

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19
Q

Tx for SBO

A

NGT placement for decompression and suction to decrease risk of aspiration
agressive fluid and electrolytes

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20
Q

tx for adhesive SBO

A

most resolve w/o surgery (more surgery means more scar tissue)
NPO, NGT, IVF
serial exams, ask about passing gas

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21
Q

Surgical for tx of adhesive SBO

A

lysis of adhesions

resect non-viable areas

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22
Q

Tx of hernias

A

Reduce hernia then send them home and repair electively

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23
Q

if a patient has a SBO and doesn’t have intrabdominal surgery or hernias what do you do?

A

exploratory laparoscopy/ laparotomy

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24
Q

Results as a persistent remnant of the vitelline duct.

A

Meckel’s Diverticulum

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25
Q

the rules of 2’s w/ Meckel’s diverticulum

A

Occurs in 2% of individuals, becomes symptomatic in 2% of cases, has 2 types of mucosa, and is found within 2 feet of the ileocecal valve, occurs 2x more often in males

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26
Q

imaging for Meckel’s Diverticulum

A

upper GI, small bowel follow through

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27
Q

most common presentation of Meckel’s Diverticulum in pediatrics

A

GI bleeding in pediatric patients

bleeding from ulceration of tissue adjacent due to gastric mucosa

28
Q

second most common presentaiton of Meckel’s diverticulum

A

diverticulus

29
Q

presentation of meckel’s diverticulum in adults

A

Obstruction most common presentation in adults secondary to herniation, intusussception, or torsion around a persistent omphalomesenteric band

30
Q

how are most cases of meckel’s diverticulum found?

A

incidentally at laparotomy for other indications

31
Q

what is used to diagnose bleeding from a Meckel’s diverticulum in a patient w/ GI bleeding and no upper or lower source

A

Tech-99 petechnetate scan

32
Q

Tx for meckel’s diverticulum

A

surgical resection if symptomatic or if reoperation would be challenging (adhesions)

33
Q

Occlusion of the mesenteric vessels secondary to arterial thrombosis (1/3) emboli (1/3), nonocclusive etiology (NOMI) (1/3)- low flow states

A

Mesenteric ischemia

34
Q

presentation w/ acute mesenteric ischemia

A

present suddenly, pain out of proportion of PE
usually >60 and a long term smoker
Hx of PVD, CAD or A-fib
HPOTN, tachy

35
Q

diagnostic for acute mesenteric ischemic (labs)

A

metabolic acidosis, lactic acid (late finding)

hemoconcentration

36
Q

what may you see on an EKG w/ acute mesenteric ischemia

A

a-fib or signs of recent MI

37
Q

what should you look for on echo w/ acute mesenteric ischemia

A

mural thrombus

38
Q

gold standard for diagnosis of acute mesenteric ischemia

A

angiography

39
Q

what will CT show w/ acute mesenteric ischemia

A

thrombus
mesenteric venous gas
pneumatosis intestinalis
bowel wall thickening, dilation

40
Q

what is the test of choice for mesenteric venous thrombosis?

A

CT abd/pelvis w/ 3D imaging

41
Q

if not peritonitis w/ acute mesenteric ischemia what do you do?

A

anticoagulate

42
Q

if peritionitis present w/ acute mesenteric ischemia what should you do?

A

Surgery, embolectomy or vascular reconstruction
evaluate viability and resect as necessary
2nd look laparotomy 24-48 hours later to visually inspect anastomosis and remaining bowel for progressive ischemia

43
Q

usually results from long-standing atherosclerotic disease of 2 or more mesenteric vessels

A

Chronic mesenteric ischemia (CMI)

44
Q

pain after eating and fear of food

A

mesenteric angina

45
Q

tx for chronic mesenteric ischemia

A

angioplasty +/- stent or bypass

46
Q

are tumors of the small bowel common?

A

No, usually benign and found incidentally

47
Q

cause of a small bowel bleeding, associated w/ Osler-Weber-Rendu syndrome

A

hemangiomas

48
Q

Rare AD disorder characterized by mucocutaneous melanotic pigmentation and multiple gastrointestinal polyps
The polyps are hamartomas and occur mostly in the jejunum and ileum
May cause bowel obstruction and to a lesser extent, GI bleed
increased chance of adenocarcinoma

A

Peutz-Jeghers Syndrome

49
Q

what is the most common malignant tumor of the small bowel

A

adenoscarincomas

50
Q 
Slow growing neuroendocrine tumor
Can be benign or malignant
Appendix most common site
Small intestine 2nd most common site
May present with obstruction, pain, bleeding or carcinoid syndrome
A

carcinoid tumors

51
Q

what is carcinoid syndrome

A

cutaneous flushing
diarrhea
bonrchoconstriction and right sided cardiac valvular dz

52
Q

what will be elevated with carcinoid tumors?

A

elevated urinary 5-HIAA (serotonin)

53
Q

tx for carcinoid tumors

A

surgical resection and debulking

octreotide (somatostatin)

54
Q

Can be benign or malignant
Can occur anywhere in the GI tract
large ones are associated w/ complications such as GI hemorrhage, obstruction, bowel perf

A

Gastrointestinal Stromal Tumors (GISTs)

55
Q

Tx for GISTs?

A

imatinib mesylate

radical and complete resection for best chance

56
Q

10 – 15% malignant small bowel neoplasms
Fatigue, malaise, weight loss and abdominal pain
25% present with perforation, obstruction intussusception or hemorrhage

A

lymphomas

57
Q

tx for lymphomas of small bowel

A

surgery for diagnosis, staging, relief of obstruction and resection or debulking
if mild obstruction- chemo

58
Q

Chronic transmural inflammation

Can involve any area of the bowel – mouth to anus, most likely to involve the ileocecal region

A

Crohn’s Disease

59
Q

Age distribution of Crohn’s Disease

A

bimodal
most showing up 15=5
second peak 55-65

60
Q

presentation of crohn’s

A 
diarrhea and abdominal pain
N/V w/ obstruction
pain is vague, aggrevated by eating
periana disease- abscesses, fissues, fistulae 
RLQ tenderness/ mass
61
Q

where are extraintestinal findings w/ Crohn’s Dz

A

Skin, joints, mouth, eyes, liver, and bile ducts

62
Q

routine labs for crohn’s

A

CBC
ESR
CRP

63
Q

what 2 tests are avaliable to attempt to differentiatie UC from Crohn’s

A

p-ANCA- ulcerative colitis

ASCA- Crohn dz

64
Q

diagnostics for Crohn’s

A

CT, BE, small bowel follow through
Enteroclysis (weight through nose to get dye in)
upper and lower endoscopy
capsulography

65
Q

Tx for Crohn’s

A

Medical
antidiarrhea
cholestyramine with terminal ileum involvement
immune supression and modulation

66
Q

who is surgery reserved for w/ someone w/ Crohn’s

A

reserved for complications due to chronic nature of the disease and risk of short gut syndrome if too much small bowel resected over time

67
Q

indications for surgery w/ Crohn’s

A 
Intractable disease
Obstruction – fairly common due to fibrosis and stricture formation
Fistula
Abscess
Perforation
Hemorrhage

*OldSurgery (22 decks)

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