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Surgery > Small Intestine > Flashcards

Small Intestine Flashcards

1
Q

The first main artery that branches off the abdominal aorta is :

A 
The celiac artery 
and then give off 3 of its own brnaches : 
1)splenic artery 
2) left gastric artery 
3) common hepatic
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2
Q

The peritoneum :

A

Double layer of serous membrane or mesothelium with 2 parts : parietal and visceral
It forms folds such as mesentries , omenta and ligaments

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3
Q

The 2 types of contractions of small bowel:

A

1) to and fro- motion mixes chyme digestive juices

2) peristaltic- contraction moves food distallyb

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4
Q

Enteroclysis :

A

Is washing out of the intestine
Minimally invasive radiographic procedure ( catheter introduction) for the small intestine followed by injection of barium and methylcellulose

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5
Q

Advantages of enteroclysis:

A 
1) increase in the distention of the lumen , which will help to determine : 
Fold thickness
Polyps
Ulceration
Constrictions 
Adhesive bands
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6
Q

USS of the abdomen can differentiate :

A

Can differentiate Fluid filled dilated small bowel loop from abdominal cystic structures

  • can assess free fluid within the peritoneal cavity
  • can assess solid mass belonging to small bowel if large enough
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7
Q

Estimation of fecal fat -normal fecal fat output is :

A

Less than 6g/day ( if standard diet of 100gr)

Most sensitive test of disorders of digestion and absorbtion

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8
Q

Causes of intestinal obstruction:

A

1) mechanical (dynamic) ->
intraluminal ( foreign bodies, faecal impaction, gallstones..)
Intramural(stricture, malignancy, volvulus..)
Extramural(bands/adhesions, hernia)
2)ileus (adynamic)->
Paralytic ileus
Pseudo-obstruction

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9
Q

Clinical features of intestinal obstruction:

A

1) colicky central abdominal pain
2) vomiting
3) abdominal distention
4) constipation

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10
Q

Treatment of acute intestinal obstruction:

A

1) GI drainage via nasogastric tube
2) fluid and electrolyte replacement
3) relief of obstruction
* surgical treatment is done after complete resuscitation

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11
Q

Indication for early surgical intervention:

A
  • obstruction of external hernia
  • clinical features suspicious of intestinal strangulation
  • obstruction in a ‘virgin’ abdomen
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12
Q

Paralytic ileus:

A

Failure of transmission of peristaltic waves 2nrdy to neuromuscular failure

-will lead to accumulation of fluid an gas within the bowel
With associated distention, vomiting , absence of bowel sounds and constipation .

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13
Q

Symptoms of acute mesenteric ischemia:

A

Sudden abdominal pain
Passage of altered blood
Shock

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14
Q

Sympt. Of chronic mesenteric ischemia:

A

Abdominal angina

Weight loss Or diarrhea

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15
Q

Treatment of mesenteric ischemia :

A

Resuscitation
Gut resection
Embolectomy
Vascular bypass or endarterectomy

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16
Q

Pathological features of Crohn’s disease:

* disease of uncertain etiology characterized by full thickness inflammatory process

A

1) Full thickness inflammation
2) Edema
3) Fissures/ ulcerations
4) Non caseating foci of epithelioid and giant cells

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17
Q

Clinical features of acute Crohn’s disease :

A
  • Pain R. Iliac fossa with tenderness
  • features of low small intestine obstruction
  • rare, perforation causing peritonitis
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18
Q

Clinical features of chronic Crohn’s diseases :

A
  • colicky abdominal pain + diarrhea
  • weight loss
  • perianal fistulas
  • fistulation into adjacent organs
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19
Q

Treatment of Crohn’s disease :

A 
✅corticosteroid 
✅aminosalicylates 
✅immunomodulators (ex. Azathioprine) 
✅monoclonal Ab
✅ Antibiotics for perianal disease 
✅ surgery: resections , strictureplasty or colectomies
20
Q

Intestinal tuberculosis:

A

Starts when ingested from infected source or from swallowed sputum from open pulmonary tuberculosis

-Pathology: ulcerations , stricture formation and LN enlargement
-General clinical features: wight loss , low grade fever , fatigue
Abdominal clinical features : distention, borborygmi, diarrhea , constipation and ulceration , palpable mass in R. Iliac fossa

21
Q

Borborygmi:

A

Rumbling or gurgling noise made by the movement of fluid and gas in the intestine

22
Q

Treatment of intestinal TB:

A

✅ Anti-tuberculosis drugs (RIFAMPIN, isoniazid, pyrazinamide, ethambutol)
✅ surgery for complications ( stricture , perforation, hemorrhage)

23
Q

Small bowel diverticulosis:

A

-duodenal diverticula: 90% asymptomatic
-Meckel’s diverticulum 40cm of the ileocecal valve, congenital anomaly, may cause bleeding, obstruction and acute inflammation
*asymptomatic Meckel’s diverticulum are left as they found , while narrow necked , inflamed or symptomatic are excised
✅treatment : resection with enterorrhaphy (stitching an intestine)

24
Q

Etiological factors for tumors of the small intestine include :

A

1) inherited conditions - polyposis coli , peutz-jegherz synd., gardner’s syndrome
2) immunocompromised states ( AIDS, coeliac disease ..)
3) geographical areas ( lymphomas more common in middle east )

25
Q

Hyper-plastic polyps:

*benign tumors have a slow growth and delayed clinical presentations.

A
  • are benign mucosal growth

* generally asymptomatic- has malignant potential

26
Q

Stromal tumors :

Leiomyomas

A
  • most common symptomatic small bowel lesions

* differentiating : between benign gut stromal tumors and malignant is difficult

27
Q

Peutz-Jeghers synd.:

A
  • autosomal dominant disorder

* mucocutaneous pigmentation( face, lips , and buccal mucosa)

28
Q

Frequent complication of hemangiomas :

A

GI bleeding

29
Q

Causes of malignant tumors in the small intestine :

A
  • genetic risk factors:
  • familial adenomatous polyposis
  • hereditary nonpolyposis colorectal cancer
  • diet
  • tabacco and alcohol
  • crohn disease
  • celiac disease
30
Q

Most common symptoms of small bowel malignant cancer:

Typically asymptomatic in the early stages

A

Abdominal pain+ weight loss

- bleeding, nausea, vomiting and obstruction are LESS COMMON

31
Q

lab studies in Malignant tumor of small intestine :

A
  • mild anemia
  • liver function tests
  • carcinoembryonic Ag levels are ↗️↗️
  • imaging studies: plain abd. X ray films , abd. CT scan
  • procedures : upper GI endoscopy, small bowel enteroscopy, colonoscopy
32
Q

Adjuvant therapy of malignant cancer :

A

✅irinotecan therapy
✅FOLFOX 4 regimen ( combination of 5-FU, oxaliplatin and leocuvorin)
✅IMATINIB mesylate

33
Q

Surgical care in tumors :

A

✅generally- wide local excision
✅proximal duodenum- pancreaticduodenectomy
✅palliation in pts with symptomatic advanced disease

34
Q

Carcinoid tumors arise from a special type of cells and produce :

A
  • > enterochromaffin cells
  • > produce : gastrin , calcitonin , insulin vasoactive intestinal peptide , neurotensin , catecholamines and corticotropin .
  • pts with these tumors have elevated urinary excretion of 5HIAA
35
Q

Carcinoid synd.:

A

Pts with this syndrome have commonly been diagnosed with irritable bowel synd. Or idiopathic flushing

*characterized :
hepatomegaly , diarrhea , flushing in 80% of pt
R. Heart valvular diseases in 50%
Asthma in 25%
*cutaneous flushing is earliest sign of the syndrome

36
Q

Some characteristics in the physical examination of carcinoid synd. :

A 
face , neck and upper chest flushing , hT
*Skin: 
Facial telangiectasis 
\+
Extremity rash
*Abdomen: 
Disetended , hepatomegaly, bowel sounds
* increased lacrimation 
*fever
*lungs- wheezing 
*heart: tricuspid valve regurgitation
Pulmonic stenosis
37
Q

Indications for small bowel transplant :

A

▪️short bowel syndrome( condition where the body cannot absorb enough nutrients from the foods intake bc of no enough SI ).
▪️irreversible intestinal failure
▪️end stage liver disease for combined liver and small intestine transplantation
▪️cong. Mucosal disorders
▪️locally invasive tumors

38
Q

Gastroschisis =

A

Birth defect where there is a hole in the abdominal wall beside the belly button

39
Q

Hirschsprung disease =

A

Birth defect in which some nerve cells are missing in the large intestine so the childs intestine cant move stool and becomes blocked

40
Q

Postoperative of small bowel transplantation:

A

*Induction therapy with :
Tacrolimus and steroids
Is typically begun most often in conjunction with an interleukin 2 receptor Ab
* high levels of immunosuppression early in the post operative period ( when the rejection risk is greatest)

41
Q

Mesentery=

+ its function

A 
The fan shaped layer of the peritoneum that suspends the jejunum and ileum from the posterior wall of the abdomen
Function: 
-keeping the guts in place 
-limiting gut movement
-protection from injury
-conduit
42
Q

Intussusception:

A

Is a serious condition in which part of the intestine slides into an adjacent part of the intestine

43
Q

Medical and surgical treatment of carcinoid syndrome :

A

Medical=
✅chemotherapy - for palliative purposes
✅radiation- palliative role
✅OCTREOTIDE- reduction of symptomes
✅Antidiarrheal- diarrhea
Surgical=
✅larger than 1.5cm segmental resection with lymphadenectomy
✅metastatic stage : resection even if only for palliation
✅obstruction lesions- resection or bypass
✅intraarterial chemotherapeutic infusion

44
Q

Rarity of Small intestinal tumors causes=

A

1) rapid intestinal transit
2) greater fluidity of small bowel chyme
3) alkaline ph
4) low bacterial colony counts
5) higher levels of benzyl peroxidase
6) increased levels of immunoglobulin A
7) widespread gut lymphoid tissue

45
Q

Mesenteric lymphadenitis:

A
  • inflammation of the LNs in mesentery
  • usually results from an intestinal infection
  • occurs mainly in children and teens
  • often mimics the signs and sympts of appendicitis
  • unlike appendicitis, it is seldom serous and clears on its own

Surgery (8 decks)

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