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General Surgery > Small Intestines Disease > Flashcards

Small Intestines Disease Flashcards

1
Q

***what are the reasons for low incidence of small bowel adenocarcinoma?

A

1-low amount of fluid, alkali & bacteria in the small intestines

2-passage is fast

3-rapid life cycle of cells

4-protective apoptotic mechanism in the small intestine wall; high igA lvl in the wall

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2
Q

Where are the adenocarcinoma most commonly found?

A

Proximal small intestines (2nd part of duodenum)

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3
Q

Where are the other malignant lesions (carcinoid tumor, lymphoma, or GIST) most commonly found?

A

Distal small intestine

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4
Q

What are the branches of the celiac artery?

A

-Splenic a.
-Left gastric a.
-Common hepatic a.

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5
Q

Which nerve plexus is found in the muscularis propria?

A

Myenteric (Auerbach’s ) plexus

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6
Q

Which plexus is found in the submucosa

A

Meissner’s plexus

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7
Q

The duodenum has no ……… and bcz of that it is considered ……..?

A

No mesentery
partially Retroperitoneal

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8
Q

where’s peyer’s patch found?

A

submucosa

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9
Q

what are the gold standard diagnostic methods in SMALL BOWEL TUMORS?

A

capsule enteroscopy(small intest) and double balloon endoscopy(whole GIS)

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10
Q

what are the symptoms of small intestine neoplasms

A

abdominal pain
obstruction
constipation

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11
Q

what is the most common benign vs malignant small intestine tumor?

A

benign: adenoma
malignant: adenocarcinoma

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12
Q

in small intestine, villous adenomas are rare and most commonly found in the duodenum and is associated with ………..?

A

familial polyposis syndrome

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13
Q

which neoplasms are premalignant lesions in small intestines and must be removed?

A

villous and true adenomas

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14
Q

Lipomas are most common in the ………. of the small intestines?

A

ileum

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15
Q

which type of polyp in the small intest is a component of Peutz-jeghers syndrome(colon dis) ?

A

hamartomatous polyp

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16
Q

in which type of neoplasm is there a *risk of malignancy due to the presence of adenomatous polyps in small intestines?

A

hamartomatous polyp

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17
Q

what is the most common symptom in hamartomatous polyp?

A

recurrent colic abdominal pain due to intussusception

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18
Q

which type of small intest tumor is
-found in jejunum
-common symptom is bleeding
-found in Osler-weber-rendu syndrome

A

hemangiomas

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19
Q

diagnostic method for hemangiomas?

A

angiography

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20
Q

what are the 2 most common symptoms of small intestine malignant tumor?

A

1-partial small bowel obstruction
2-painless bleeding

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21
Q

which one is more common in small intestine tumors; metastatic or primary tumors?

A

metastatic>

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22
Q

if a patient has crohn’s , where can the adenocarcinomas be found?

A

ileum (usually in the duodenum)

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23
Q

do adenocarcinomas have poor or high prognosis?

A

poor prognosis

24
Q

whipple procedure is performed in patients with?

A

adenocarcinoma

25
Q

what is the tx for adenocarcinoma?

A

colon resection

26
Q

** which tumor originates from Cajal cells(mesenchymal cells located within the muscle layers of the alimentary tract that mediate communication between the *autonomic nervous system and smooth muscle)?

A

Gastrointestinal stromal tumors GIST

27
Q

the defining feature of GIST is the expression of …….?

A

tyrosine kinase KIT receptor

28
Q

**which small intestine neoplasm causes lymph node metastasis?

A

adenocarcinoma s.a diffuse gastric ca (unlike GIST**)

29
Q

what are the 2 drugs used to treat GIST?

A

Imatinib(adjuvant therapy; Treatment given after the main treatment to reduce the chance of cancer coming back by destroying any remaining cancer cells)
& Sunitinib(in case of resistance to imatinib)

30
Q

chemotherapy has no proven efficacy in tx of ………

A

adenocarcinoma

31
Q

***which tumor originates from enterochromaffin (neuroendocrine)cells?

A

carcinoid tumors

32
Q

***what does the carcinoid tumor secrete?

A

serotonin, substance P, and histamine

33
Q

70% of the time appendiceal carcinoid tumors are ……

A

solitary(single)

34
Q

3 places in GIS Where carcinoid tumors can be found?

A

1-appendix(solitary)
2-small intestine(multiple)
3-rectum

35
Q

in which part of the GIST is the tumor size imp?

A

in the small intestine (not in colon)

36
Q

***tx for carcinoid tumor?

A

somatostatin receptor scintigraphy [ocreotide] (reduces the secretion of histamine, serotonin, and substance p)

37
Q
A
38
Q

***In carcinoid syndrome patients with elevated CgA and …… together have a shorter survival rate?

A

NT-pro BNP

39
Q

Which method is not used for diagnosis of carcinoid tumor?

A

MR (used in dx of metastatic disease esp liver metastasis)

40
Q

Which drug is effective in palliating the symptoms of carcinoid syndrome?

A

Octreotide

41
Q

**which tumor originates from neuroendocrine cells?

A

Carcinoid tumor

42
Q

Most common small intest benign tumor symptom?

A

Bleeding &pain

43
Q

Most common small intest malignant tumor symptom?

A

Obstruction

44
Q

In carcinoid syndrome most patients have metastasis in which organ?

A

Liver metastasis bcz THEY BYPASS THE PORTAL VEIN AND VENA CAVA

45
Q

What are the most common symptoms of carcinoid syndrome?

A

Episodic flush, bronchospasm, diarrhea and vasomotor collapse attacks
(Bcz of the serotonin, subs P, and histamine secretions )

46
Q

Which molecule’s level do you measure to know serotonin levels?

A

Circulating serotonin is metabolized in the liver to 5-hydroxyindolacetic acid (5-HIAA).
The level of 5-HIAA in the urine can be measured.

47
Q

……….is the most common true diverticulum of the small intestine.

A

Meckel’s diverticulum

48
Q

……. diverticula of the small intestine are most often in the duodenum.

A

Acquired

49
Q

***what are the rule of 2’s in Meckel’s divertulum?

A

-in 2% of population
-2 feet from ileocecal valve
-2inches long
- 2x common in men
-2 genera of heterotopic (ectopic) tissues;stomach and pancreas
-symptoms under 2 years of age

50
Q

Definition of short bowel syndrome?

A

Small intestine < 200 cm short bowel syndrome—> not enough intestinal length for feeding

51
Q

What are the causes of small bowel resection leading to short bowel syndrome?

A

-Mesenteric vessel occlusion
-Crohn’s
-mesenteric vascular injury

52
Q

What is the tx for short bowel syndrome?

A

Iv fluid

53
Q

What is stage 1 short bowel syndrome tx?

A

Fluid electrolyte therapy and TPN (total parenteral nutrition)

54
Q

At which stage of short bowel syndrome does anemia, hyperoxaluria, or hypomagnesemia, or gallstones/kidney stones ?

A

Stage 3

55
Q

At which stage of short bowel syndrome does intestinal adaptation begins?

A

Stage 2

56
Q

**Describe the treatment for short bowel syndrome?

A

Stage 1: Fluid-electrolyte therapy and TPN(Total parenteral nutrition)

Stage2: TPN continues

Stage3: Iron, vitamin B12, folate, magnesium and vitamin D are given in addition to the normal diet.

General Surgery (28 decks)

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