Tumours of the small bowel

Question 1

What are the benign tumours of the small bowels

Answer 1

Leiomyoma
Adenoma
Lipomas
Haemangiomas

Heterotopic tissues:
- Heterotopic pancreas: small submucosal tumours
- Endometriosis: small mass in ilieum

Question 2

Explain Leiomyomas in terms of:
- Location
- Appearance

Answer 2

Location:
- It arises from the muscle wall and can grow into the lumen. Distributed in the Jejunum and Ilieum

Appearance:
- Sperical mass on scans

Question 3

What is an adenoma of the small bowel and where is it found

Answer 3

Tubular adenomas with very high malignant potential.

Usualy only affects a single segment

Can occur as part of FAP or sporadic

Question 4

Where are lipomas and haemangiomas found

Answer 4

Lipomas: Typically duodenum or distal small bowel

Haemangiomas: Mostly found in jejunum

Question 5

What is a neurogenic tumour and which is the most common

Answer 5

Tumour that arises from neural tissue

Neurofibromatosis

Question 6

What are the different polyposis syndromes

Answer 6

Familial adenomatous polyposis
- Multiple adenomas in the colon with high malignant potential
- 80% have small bowel involvement

Peutz-Jegners syndrome
- Affects mainly jejenum and ileum
- Melanin spots of oral mucosa, toes, fingers

Juvenile polyposis
- Inherited or sporadic

Canada syndrome
-Characterised by:
- Alopecia, atrophy of finger nails, diarhoea
- Protein losing enteropathy

Question 7

Which areas are affected by adenocarcinoma

Answer 7

Duodenum is most commonly affected

Question 8

Explain carcinoids in terms of the following:
- Tissue of originates
- Site
- symptoms

Answer 8

Tissue originating:
- Enterochromaffine cells

Site:
- Common in the ilieum

Symptoms:
- Flushing
- Palpitations
- Diarrhoea
- Bronchospasm
- Congestivecardiacfailure

Question 9

Diagnosis and management of neuroendocrine tumours

Answer 9

Chromogranin A
Octreotide scan
Management: Surgical resection
Chemotherapy
Somatostatin analogues

Question 10

Explain lymphomas of the small bowel in terms of:
- Origin
- Affected site
- Symptoms

Answer 10

Origin:
- Arrises from MALT

Affected site:
- Commonly affects ilieum

Symptoms:
- Fever, pain, diarrhoe, weight loss.

Question 11

Explain sarcomas of the small bowel in terms of:
- Origin
- Site

Answer 11

Origin:
- Arises from smooth muscles of bowel or blood vessels

Site:
- Affect jejenum and ileum
- Commonly in Meckel diverticulum

Question 12

What is the clincial presentation of a patient with small bowel tumour

Answer 12

∗ Weight loss
∗ Colicky abdominal pain
∗ GIT haemorrhage and anaemia
∗ Vomiting , diarrhoea
∗ Duodenal tumours: obstructive jaundice, gastric outlet obstruction
∗ Abdominal mass
∗ Hormonal related symptoms

Question 13

What are the diagnostic studies for small bowel tumours

Answer 13

• FBC (Anaemia)
• AXR: subacute obstruction
• Small bowel enema/ Enteroclysis Double balloon endoscopy
• Video capsule
• MDCT
• Laparotomy
• CT Enteroclysis
• Endoscopy

Question 14

What is the management for a patient with a small bowel tumour

Answer 14

∗ Surgical resection: Only hope of cure.
∗ Duodenal: whipple procedure/ PPPD.
∗ Surgical enucleation: Benign
∗ Segmental resection.
∗ Colectomy for distal ileum tumours.
∗ Palliative resection for symptoms relief.
∗ By-pass surgery.
∗ Adjuvant therapy.