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SR 44 - Small Intestine Flashcards

1
Q

How long is the duodenum?

A

12 inches

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2
Q

What marks the end of the duodenum and the start of the jejunum?

A

Ligament of Treitz

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3
Q

What is the length of the entire small bowel?

A

~6 meters (20 feet)

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4
Q

What is the blood supply for the small bowel?

A

Branches of the superior mesenteric artery

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5
Q

What does the small bowel do?

A

Major site of digestion and absorption

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6
Q

What does the terminal ileum absorb?

A

B12
Fatty acids
Bile salts

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7
Q

What are the major difference between the jejunum and ileum?

A

Jejunum - long, large, thick
Ileum - short, small, thin

Vasa recta, plicae circulares, wall

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8
Q

Signs and symptoms of a SBO?

A 
Abdominal discomfort
Cramping
Nausea
Abdominal distention
Emesis
High-pitched bowel sounds
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9
Q

What lab tests are performed with a SBO?

A

Electrolytes
CBC
Type and screen
Urinalysis

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10
Q

What are the classic acid-base/electrolyte findings with proximal SBO?

A

Hypovolemic, hypochloremic, hypokalemic alkalosis

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11
Q

What must be ruled out on physical exam in patients with SBO?

A

Incarcerated hernia

Also look for surgical scars - increased risk of adhesions

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12
Q

What are major AXR findings are associated with SBO?

A

Distended loops of small bowel

Air-fluid levels on upright film

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13
Q

Define a complete SBO

A

Complete obstruction of the lumen

Little to know colon gas

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14
Q

What is the danger of a complete SBO?

A

Closed loop strangulation of the bowel leading to bowel necrosis, and potential perforation

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15
Q

Define parial SBO

A

Incomplete SBO

Some colon gas (may still be passing gas)

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16
Q

What is the initial treatment of patients with SBO?

A

NPO
NGT
IVF
Foley

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17
Q

What test can differentiate partial from complete bowel obstruction?

A

C with oral contrast and small bowel follow-through

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18
Q

What are the causes of SBO?

A

The ABCs

  • Adhesions
  • Bulge (hernias)
  • Cancer and tumors
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19
Q

What are lesser cause of SBO?

A

After adhesions, hernias and cancer:

  • Gallstone ileus
  • Intussusception
  • Volvulus
  • External compression
  • SMA syndrome
  • Bezoars, bowel wall hematoma
  • Abscesses
  • Diverticulitis
  • Crohn’s disease
  • Radiation enteritis
  • Annular pancreas
  • Meckel’s diverticulum
  • Peritoneal adhesions
  • Stricture

‘GIVES BAD CRAMPS’

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20
Q

What is the superior mesenteric artery (SMA) syndrome?

A

SMA compresses the duodenum causing obstruction

Seen with weight loss

21
Q

What is the treatment of complete SBO?

A

Laparotomy and lysis of adhesions

22
Q

What is the treatment of incomplete SBO?

A

Initially, conservative treatment with close observation plus NGT decompression

23
Q

How do you, intraoperatively, determin the level of obstruction in a SBO?

A

Transtion from dilated bowel proximal to the decompressed bowel distal to the obstruction

24
Q

What is the most common indication for abdominal surgeyr in patients iwth Crohn’s disease?

25
Can a patient have a complete SBO and bowel movements/flatus?
Yes - the bowel distal to the obstruction can clear out gas and stool taht was there already
26
After a small bowel resection, why should the mesenteric defect always be closed?
To prevent an internal hernia
27
What ma cause SBO if patient is on coumadin?
Bowel wall hematoma
28
What is the #1 cause of SBO in adults in industrialized nations?
Postoperative adhesions
29
What is the #1 cause of SBO around the world?
Hernias
30
What is the #1 cause of SBO in children?
Hernias
31
What are the signs of strangulated bowel with SBO?
Fever, severe/continuous pain, hematemesis, shock, gas in teh bowel wall or portal vein, abdominal free air, peritoneal signs, acidosis (increased lactic acid)
32
What are the clinical parameters that will lower the threshold to operate on a partial SBO?
Increasing WBC Fever Tachycardia/tachypnea Abdominal pain
33
What is an absolute indicateion for operation with partial SBO?
Peritoneal signs | Free air on AXR
34
What condition commonly mimics SBO?
Paralytic ileus | AXR reveals gas distention throughout, including the colon
35
What is the different diagnosis of paralytic ileus (nonobstructive)?
Postop ileus after abdominal surgery (resolves in 3-5 days) Electrolyte abnormalities (hypokalemia) Medications (anticholinergics, narcotics) Inflammatory intra-abdominal process Sepsis/shock Spine injury Retroperitoneal hemorrhage
36
What tumor classically causes SBO due to 'mesenteric fibrosis'?
Carcinoid tumor
37
What are the different small bowel tumors?
``` Leiomyoma Lipma Lymphangioma Fibroma Adenomas Hemangiomas ```
38
What are the signs and symptoms of small bowel tumors?
Abdominal pain Weight loss Obstruction Perforation
39
Most common benign small bowel tumor?
Leiomyoma
40
Most common malignant small bowel tumor?
Adenocarcinoma
41
What is the work up fof a small bowel tumor?
UGI with small bowel follow-through Enteroclysis CT scan Enteroscopy
42
What malignancy is classifcally associated with metastasis to small bowel?
Melanoma
43
What is a Meckel's diverticulum?
Remnant of the omphalomesenteric duct/vitelline duct, which connects the yolk sac the preimitive midgut in the embryo
44
Where is a Meckel's diverticulum located?
Within 2 feett of the ileocecal valve on the antimesenteric border of the bowel
45
Possible complications of Meckel's diverticulum?
``` Intestinal hemorrhage (painless) Intestinal obstruction Inflammation+/- perforation ```
46
What heterotopic tissue type is found in Meckel's diverticulum?
``` Gastric mucosa (60%) Duodenal, pancreatic, colonic mucosa ```
47
What is a Meckel's scan?
Can for ectopic gastric mucosa in Meckel's diverticulum Uses technetium pertechnetate IV Preferentially taken up by gastric mucosa
48
What is the most common cause of small bowel bleeding?
Small bowel angiodysplasia

Surgical Recall (32 decks)

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