Surgical Talk: Small intestine and colon Flashcards
Describe Meckel’s diverticulum
Remnant of vitelline duct found in 2% of population, approximately 2ft proximal to iliocaecal valve, 2in long (very variable) [hence 2,2,2]. Often asymptomatic and discovered inceidentally on laparotomy but may present acutely with bleeding, volvulus, intussusception or mimicking appendicitis.
Treatment of Meckel’s diverticulum?
Resus, pain management, surgical excision.
What is the commonest cause of major GI bleed in teenagers? What is the aetiology?
Bleeding Meckel’s diverticulum, sometimes caused by ectopic gastric mucosa.
What investigation could you perform in a patient with suspected intestinal bleeding to confirm Meckel’s diverticulum? How does it work?
Technetium scan.
Technetate is taken up and secreted by gastric mucosa and thus will reveal ectopic gastric mucosa present in Meckel’s diverticulum.
Tell me about small bowel tumours.
Small bowel tumours are relatively rare and may arise from any element of the bowel wall or surrounding tissues and may be primary or secondary, benign or malignant. [continue to list by classification]
Tell me about benign tumours of the small bowel.
Benign tumours may arise from fat tissue (lipomas), smooth muscle (leiomyomas), nerves (neurofibromas) or glandular mucosa (adenomas). Small bowel adenomatous polyps may be premalignant and associated with polyposis syndromes such as Peutz-Jeghers or FAP.
How might a patient with a benign small bowel tumour present?
Incidental finding, bleeding (anaemia/malaena/FOB), intussusception.
Tell me about malignant tumours of the small bowel.
Malignant tumours of the small bowel can arise as adenocarcinoma arising from pre-existing polyps. Lymphomas, leiomyosarcomas and carcinoid tumours may also arise. Metastases from lung, breast or melanoma may occur.
Why might a carcinoid tumour of the small bowel go undetected?
The 5-HT and bradykinin secreted by carcinoid tumours in the bowel undergoes first-pass metabolism and thus the patient may not suffer from the carcinoid syndrome (flushing, bronchospasm and diarrhoea).
Define intussusception.
A condition where a portion of the intestine becomes invaginated by peristalsis into its own lumen.
Tell me about intussusception.
Most commonly seen in children, usually in first year of life. In adults, a tumour may be acting as the apex and should be investigated. It may present with colicky abdominal pain, obstruction and possibly the passing of ‘redcurrant jelly’ stools (blood and mucus). There may be a mass palpable on abdominal examination and in some cases the apex may be visible or palpable on rectal examination.
Prompt treatment is required to avoid strangulation and infarction.
Treatment of intussusception?
In children: Barium enema/surgery
In adults: surgery, often resection
