small intestine Flashcards
Where is calcium primarily absorbed
duodenum
produced by D cells
somatostatin
Produced by G cells
Gastrin
Produced by I cells
Cholecystokinin
Produced by M cells
Motilin
Produced by L cells
- peptide YY
2. Glucagon like peptide
Produced by S cells
Secretin
Inhibits Gi secretion, motility and splanchnic perfusion
somatostatin
Stimulates exocrine pancreatic secretion, stimulate intestinal secretion
secretin
Stimulate exocrine pancreatic secretion, stimulate gallbladder emptying
cholecystokinin
stimulate intestinal motility
motilin
stimulate intestinal proliferation
glucagon like peptide 2
inhibit intestinal motility and secretion
peptide YY
Most common cause of small bowel obstruction
intraabdominal adhesion
What portion of the duodenum is compressed in superior mesenteric artery syndrome
3rd portion of duodenum
What is the confirmatory test of small bowel obstruction
abdominal series
Triad of small bowel obstruction in radiograph
- dilated small bowel loops >3 cm
- air fluid level
- paucity of air in the colon
What is another name for acute colonic pseudo obstruction
ogilvie syndrome
treatment of ogilvie syndrome
IV neostigmine
Iv atropine to counteract bradycardia
What is the normal temporal pattern of GI motility
24 hours - small intestine
48 hours - gastric motility
3 - 5 days - colonic motility
Inraoperative measure to reduce ileus
- minimize handling of bowel
- laparoscopic approach
- avoid exxcessive intraoperative fluid administration
Post operative measures to reduce ileus
- early enteral feeding
- epidural anesthesia, if indicated
- avoid excessive IV fluid administration
- correct electrolyte abnormality
- consider M opioid antagonist
Treatment of crohn’s disease
Sulfasalazine + steroids
Treatment of ulcerative colitis
Sulfasalazine + steroids
Earliest leion of crohn’s disease
aphthous ulcer
This is pathognomonic of crohn’s disease: encroachment of mesenteric fat onto the serosal surface of the bowel
fat wrapping
Lead pipe colon (lacks hautral markings)
ulcerative colitis
Most common area affected by crohn’s disease
distal ileum
Most common cause of enterocutaneous fistula
iatrogenic
What is a low output fistula
less than 200 ml/day
What is a high output fistula
more than 500 ml/day
90% of fistula are going to close within how many weeks interval
5 weeks
Most useful initial test in a fistula
CT scan
Fistula usually manifest in how many post operative days
5th to 10th post operative day
What are the factors that inhibit closure of fistula?
FRIEND
Most common benign neoplasm of small intestine
Adenoma
Most common location for primary adenocarcinoma and adenoma in small bowel
duodenum
Most common location of GIST
stomach (60 - 70%)
Most common mode of presentation of adenocarcinoma in the small bowel
Partial small bowel obstruction
What is the most commonly affected area of radiation enteritis
Terminal Ileum
Most accurate way to diagnose radiation enteritis
enteroclysis
Treatment of radiation enteritis
supportive therapy
Most common heterotropic muscosa of meckel’s diverticulum
gastric mucosa (60%)
Most prevalent congenital anomaly of the GI tract
Meckel’s diverticulum
Pathology of Meckel’s Diverticulum
Failure of ophalomesenteric (vitelline) duct to undergo obliteration during the 8th week of gestation
Most common sign of meckel’s diverticulum
bleeding in pediatrics
intestinal obstruction in adults
Treatment of meckel’s diverticulum
diverticulectomy
It is the most sensitive test to detect jejunoileal diverticula
enteroclysis
Most common’s of acute mesenteric ischemmia
- MCC - arterial embolus
- Most common source - heart
- most common location - SMA
Golder period of mesenteric ischemia
3 hours - intestinal sloughing
6 hours - full thickness intestinal infarction
Most common symptom of chronic mesenteric ischemia
postprandial abdominal pain
Diagnostic exam of choice for itussuception
CT scan: Target Sign
Where can the base of the appendix always be found
confluence of the taenia
What is a constant symptom of appendicitis
anorexia
What is the most common surgical emergency in pregnancy
appendicitis
-usually occurs in 2nd trimester
Most consistent sign of appendicitis in pregnant woman
pain in right side of the abdomen
Most common carcinoid appendiceal tumor
carcinoid - appendix (50%)
Treatment of carcinoid tumor
< 2 cm at distal appendix - appendectomy
> 2 cm at base - right hemicolectomy
