Small bowel disorders

Question 1

What are the surgical indications for Crohn’s disease?

Answer 1

Failure of medical treatment
Complications
Failure to grow in children despite medical treatment
Perianal sepsis
Cancer

Question 2

Name 3 complications of Crohn’s disease

Answer 2

Obstruction
Perforation
Abscess
Enterocutaneous fistula
Toxic dilatation

Question 3

Define adhesions

Answer 3

Fibrous bands that form between tissues and organs, often as a result of surgery.

Question 4

Besides surgery, name 2 other causes of adhesions

Answer 4

Trauma

Intra-abdominal infection (e.g. salpingitis, appendicitis)

Question 5

What is the correlation between surgical history and adhesions?

Answer 5

Greater magnitude of surgery may cause more adhesions, but not always.

Adhesions can appear many years after a surgical procedure.

Question 6

Compare the incidence of small bowel cancers to colorectal cancers

Answer 6

Small bowel cancers: 1,500 a year in UK

Colorectal cancers: 41,300 a year in UK

Question 7

Where are the majority of small bowel cancers located?

Answer 7

Duodenum

Question 8

Name 3 risk factors for small bowel cancer

Answer 8

Age - average age of diagnosis is 66yr
Familial adenomatous polyposis (FAP)
Lynch syndrome (HNPPC)
Peutz Jeghers syndrome
Crohn’s disease - 2% develop small bowel cancer
Coeliac disease?
Diet rich in red meat or smoked foods, or high fat diet

Question 9

What are the 2 commonest types of small bowel cancer?

Answer 9

Adenocarcinomas (40%) - duodenum
Carcinoid tumours (40%) - appendix or ileum

Lymphomas (10%) - jejunum

Question 10

How does small bowel cancer present?

Answer 10

Abdominal pain
Weight loss
NaV
Diarrhoea
Fatigue/anaemia

Question 11

Outline the general management options of small bowel cancers

Answer 11

Surgery
Radiotherapy
Chemotherapy
Biological therapies