Small Intestines Disease Flashcards
***what are the reasons for low incidence of small bowel adenocarcinoma?
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
Where are the adenocarcinoma most commonly found?
Proximal small intestines (2nd part of duodenum)
Where are the other malignant lesions (carcinoid tumor, lymphoma, or GIST) most commonly found?
Distal small intestine
What are the branches of the celiac artery?
-Splenic a.
-Left gastric a.
-Common hepatic a.
Which nerve plexus is found in the muscularis propria?
Myenteric (Auerbach’s ) plexus
Which plexus is found in the submucosa
Meissner’s plexus
The duodenum has no ……… and bcz of that it is considered ……..?
No mesentery
partially Retroperitoneal
where’s peyer’s patch found?
submucosa
what are the gold standard diagnostic methods in SMALL BOWEL TUMORS?
capsule enteroscopy(small intest) and double balloon endoscopy(whole GIS)
what are the symptoms of small intestine neoplasms
abdominal pain
obstruction
constipation
what is the most common benign vs malignant small intestine tumor?
benign: adenoma
malignant: adenocarcinoma
in small intestine, villous adenomas are rare and most commonly found in the duodenum and is associated with ………..?
familial polyposis syndrome
which neoplasms are premalignant lesions in small intestines and must be removed?
villous and true adenomas
Lipomas are most common in the ………. of the small intestines?
ileum
which type of polyp in the small intest is a component of Peutz-jeghers syndrome(colon dis) ?
hamartomatous polyp
in which type of neoplasm is there a *risk of malignancy due to the presence of adenomatous polyps in small intestines?
hamartomatous polyp
what is the most common symptom in hamartomatous polyp?
recurrent colic abdominal pain due to intussusception
which type of small intest tumor is
-found in jejunum
-common symptom is bleeding
-found in Osler-weber-rendu syndrome
hemangiomas
diagnostic method for hemangiomas?
angiography
what are the 2 most common symptoms of small intestine malignant tumor?
1-partial small bowel obstruction
2-painless bleeding
which one is more common in small intestine tumors; metastatic or primary tumors?
metastatic>
if a patient has crohn’s , where can the adenocarcinomas be found?
ileum (usually in the duodenum)
do adenocarcinomas have poor or high prognosis?
poor prognosis
whipple procedure is performed in patients with?
adenocarcinoma
what is the tx for adenocarcinoma?
colon resection
** 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)?
Gastrointestinal stromal tumors GIST
the defining feature of GIST is the expression of …….?
tyrosine kinase KIT receptor
**which small intestine neoplasm causes lymph node metastasis?
adenocarcinoma s.a diffuse gastric ca (unlike GIST**)
what are the 2 drugs used to treat GIST?
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)
chemotherapy has no proven efficacy in tx of ………
adenocarcinoma
***which tumor originates from enterochromaffin (neuroendocrine)cells?
carcinoid tumors
***what does the carcinoid tumor secrete?
serotonin, substance P, and histamine
70% of the time appendiceal carcinoid tumors are ……
solitary(single)
3 places in GIS Where carcinoid tumors can be found?
1-appendix(solitary)
2-small intestine(multiple)
3-rectum
in which part of the GIST is the tumor size imp?
in the small intestine (not in colon)
***tx for carcinoid tumor?
somatostatin receptor scintigraphy [ocreotide] (reduces the secretion of histamine, serotonin, and substance p)
***In carcinoid syndrome patients with elevated CgA and …… together have a shorter survival rate?
NT-pro BNP
Which method is not used for diagnosis of carcinoid tumor?
MR (used in dx of metastatic disease esp liver metastasis)
Which drug is effective in palliating the symptoms of carcinoid syndrome?
Octreotide
**which tumor originates from neuroendocrine cells?
Carcinoid tumor
Most common small intest benign tumor symptom?
Bleeding &pain
Most common small intest malignant tumor symptom?
Obstruction
In carcinoid syndrome most patients have metastasis in which organ?
Liver metastasis bcz THEY BYPASS THE PORTAL VEIN AND VENA CAVA
What are the most common symptoms of carcinoid syndrome?
Episodic flush, bronchospasm, diarrhea and vasomotor collapse attacks
(Bcz of the serotonin, subs P, and histamine secretions )
Which molecule’s level do you measure to know serotonin levels?
Circulating serotonin is metabolized in the liver to 5-hydroxyindolacetic acid (5-HIAA).
The level of 5-HIAA in the urine can be measured.
……….is the most common true diverticulum of the small intestine.
Meckel’s diverticulum
……. diverticula of the small intestine are most often in the duodenum.
Acquired
***what are the rule of 2’s in Meckel’s divertulum?
-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
Definition of short bowel syndrome?
Small intestine < 200 cm short bowel syndrome—> not enough intestinal length for feeding
What are the causes of small bowel resection leading to short bowel syndrome?
-Mesenteric vessel occlusion
-Crohn’s
-mesenteric vascular injury
What is the tx for short bowel syndrome?
Iv fluid
What is stage 1 short bowel syndrome tx?
Fluid electrolyte therapy and TPN (total parenteral nutrition)
At which stage of short bowel syndrome does anemia, hyperoxaluria, or hypomagnesemia, or gallstones/kidney stones ?
Stage 3
At which stage of short bowel syndrome does intestinal adaptation begins?
Stage 2
**Describe the treatment for short bowel syndrome?
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.
