small intestines Flashcards
length of small intestines
6meters
mostly retroperitoneal
duodenum
mesodermally derived structures
parietal and visceral peritoneum
peritoneal cavity
extracoelomic herniation
5th week AOG
s.i. retracted back to abdominal cavity; undergoes 270 degree counterclockwise rotation around the SMA
10th week AOG
MC SURGICAL d/o of the small intestines
small bowel obstruction
cardinal signs of partial/complete sbo
vomiting
obstipation
distention
crampy abdominal pain
signs of strangulated SBO
Abdominal pain disproportionate to pe findings
tachycardia and leukocytosis
marked acidosis and hyperkalemia
triad radiographic findings SBO
DAP
dilated bowel loops >3cm
air fluid level
paucity of air in the colon
high pitched mettalic tinkling sound (water dripping into a large hollow container)
air fluid level in sbo
slushing soung (succusion splash)
SBO
Thickened small bowel loops
thumb printing sign
Pneumatosis intestinalis
pneumoperitoneum
strangulated SBO
can distinguish between ileus and mechanical SBO
CT scan
c or u shaped loop of bowel with its mesenteric vessels converging towards the point of constriction
closed loop obstruction
gold standard imaging to differentiate between partial and complete obstruction
Small bowel series/ enteroclysis
contraindications to non surgical treatment for SBO
Suspected ischemia large bowel obstruction closed loop obstruction strangulated hernia perforation
abnormal communication between two epithelialized surfaces
fistula
most small bowel fistula are
post op complications
intestinal fistulas are usually spontaneous and are difficult to diagnose
internal fistulas
direct communication between the intestine and the skin of the abdominal wall
external fistula
factors that inhibit spontaneous closure of fistula
FRIEND Foreign body radiation infection epithelialization neoplasm distal obstruction
most ideal period of fistula closure
10 days to 4 months
adeno carcinoma of small bowel
duodenum
excluding adenoca, malignant small bowel tumors are more common in
distal bowel- ileum
tx for small bowel lymphoma
primary chemo (CHOP procedure)
most prevalent congenital anomaly of the GIT
true diverticulum
60% w/ heterotopic mucosa (pancreas/ gastric)
Meckel’s diverticulum
meckels are usually found in__
ileum
persistence of vitelline and omphalomesenteric duct
meckel’s diverticulum
for narrow-based meckel’s
diverticulectomy
wide-based- segmental resection
mc cause of acute mesenteric ischemia
arterial embolus
95% with cardiac disease
meseteric ischemia usually with atherosclerotic disease
arterial thrombosis
usually Along proximal SMA CLOSE TO ORIGIN
golden period of acute mesenteric ischemia
6 hrs
insidiously develop
results from atherosclerotic lesions in the main splanchnic arteries (celiac, SMA, IMA)
Chronic mesenteric ischemia
treatment for NOMI (Non occlusive mesenteric ischemia)
vasodilators papaverine
pigtail sign in midgut volvulus (bowel loops spiraling about the axis of the mesenteric vessels)
Abnormal C loop of duodenum in the UGIS
Cecum at RUQ
MALROTATION
Tx for malrotation
IV hydration
NG suction
Ladd procedure
intermittent, colicky abdominal pain
currant jelly stools
sausage-shaped mass
hyperactive bowel sounds
intussusception
(+) dance sign
pseudokidney sign
target/ donut sign
intussusception
tx intussusception
air then hydrostatic reduction barium enema
non passage of meconium in the 1st 24 hrs of life
maternal polyhydramnios
billous emesis
intestinal atresia
apple peel atresia
IIIB
mucosal atresia with intact bowel wall and mesentery
I
BLIND END separated by a v shaped defect
IIIA
BLIND END separated by a CORD
II
Multiple atresia( string of sausages)
IV
Family history of cyctic fibrosis
food intolerance
billous emesis
meconium ileus
soap bubble sign
ground glass appearance
microcolon and egg shell pattern
inspissated meconium
meconium ileus
double bubble sign is seen in
duodenal atresia- mc
duodenal web
annular pancreas
mc and lethal gastrointestinal d/o affecting preterm neonate
necrotizing enterocolitis
necrotizing enterocolitis usually affects
terminal ileum
indication of surgery in necrotizing enterocolitis
pneumoperitoneum
most potent intestinotrophic hormones
GLP-2
MOst common subtype of short bowel syndrome
TYPE 2- small bowel resection with partial colon resection
best tolerated subtype of short bowel syndrome
TYPE 3- small int resection with SB anastomosis w/ intact colon
presence of less than 200cm residual small bowel
short bowel syndrome
