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SB82 Small Bowel

SB82 Small Bowel - Loosely taken from Fiser's ABSITE review

Location in the duodenum where 90% of ulcers occur ________ Bulb
Which portions of the duodenum are retroperitoneal? Descending and transverse
Normal length of jejunum 100 cm
What is the difference between the vasa recta and muscle folds of the jejunum and the ileum? Jejunum – long vasa recta and circular muscle folds; Ileum – short vasa recta and flat mucosa
Which part of the intestine re-absorbs non-conjugated versus conjugated bilirubin? Non-conjugated – ileum; conjugated – terminal ileum
What substances are often deficient in terminal ileal resection? B12, folate, bile acids
What percentage of the intestinal water is re-absorbed in the jejunum? 90%
What is the normal length of ileum? 150 cm
What is secreted by Brunner’s glands? Alkaline mucus
Four phases of the MMC Rest, acceleration/gallbladder contraction, peristalsis, deceleration
Most important hormone in the MMC Motilin
50% of bile acids are passively reabsorbed in these locations Ileum and colon
50% of bile acids are actively reabsorbed in the __________ Terminal ileum
Diagnosis of short gut syndrome is made on the basis of what? It is a clinical diagnosis, not based on length of gut
You suspect a patient has short gut syndrome. What tests should you order to check on malabsorption? Sudan red stain to check for fecal fat, and Schilling test to detect B12 absorption
How much gut do you need to survive off TPN, with and without a competent ileocecal valve? 75 cm without, 50 cm with
How does gastric hypersecretion of acid interfere with fat absorption? Decreased intestinal pH causes increased intestinal motility, interfering with fat absorption
“FRIENDS” of a fistula Foreign body, Radiation, Inflammation (IBD), Epithelialization, Neoplasm, Distal obstruction, Sepsis/Infection
High-output fistulas are more likely in what location? _________ Proximal bowel
Fistulas in what location are most likely to close? _________ Colon
What percentage of fistulas close spontaneously? 40%
Obstruction of small and large bowel without previous surgery (respectively) Hernia, cancer
Obstruction of small and large bowel WITH previous surgery (respectively) Adhesions, cancer
Conservative management (bowel rest, NPO, NG) cures what percentage of partial small bowel obstructions? 80%
Conservative management (bowel rest, NPO, NG) cures what percentage of COMPLETE small bowel obstructions? 20-40%
Definition of gallstone ileus Small bowel obstruction from a gallstone obstruction the terminal ileum
Classic imaging found with gallstone ileus Evidence of small bowel obstruction with air in the biliary tree
Cause of gallstone ileus Fistula between the gallbladder and duodenum allows a gallstone to pass into the intestine, where it is larger than the opening to the TI and obstructs it
Common facts about Meckel’s diverticulum Within 2 feet of ileocecal valve, 2% of the population, presents in first 2 years of life
Cause of Meckel’s diverticulum Failure of obliteration of the omphalomesenteric duct
Most common tissue type found within a Meckel’s diverticulum ___________ Gastric
Indications for diverticulectomy of Meckel’s Gastric mucosa inside (diverticulum feels thick) or has a very narrow neck
Indications for segmental resection of Meckel’s Complicated diverticulitis, neck > 1/3 the diameter of the bowel lumen, diverticulitis involving the base
A patient presents with a duodenal diverticulum. What other condition should you rule out? ________________ Chronic cholecystitis
Indications for surgical intervention for a duodenal diverticulum Perforation, bleeding, obstruction, symptomatic
Normal age for first presentation of Crohn’s disease 15-35 yo
Portion of the bowel most commonly involved in Crohn’s disease ___________ Terminal ileum
Most common symptom of Crohn’s disease ________ Anal skin tags
A patient with Crohn’s disease has an anal fissure. What treatment should you AVOID? ___________ Lateral sphincterotomy
Treatment for incidental finding of IBD in a patient with suspected appendicitis Remove appendix if cecum is not involved in inflammation
Cells that produce serotonin Kulchitsky cells (aka enterochromaffin cells)
Substance to test for in urine with suspected carcinoid syndrome 5-HIAA (breakdown product of serotonin)
Amino acid precursor to serotonin ___________ Tryptophan
Tryptophan use can lead to this disease Pellagra (diarrhea, dermatitis, dementia)
Hallmark symptoms of carcinoid syndrome Flushing and diarrhea
A patient has flushing, diarrhea, and small bowel lesion. What disease process do you suspect? Carcinoid tumor in small bowel with liver metastases (liver usually clears serotonin)
The most common site for carcinoid tumors _____________ Appendix
Indications for appendectomy for appendiceal carcinoid tumor < 2cm diameter and > 1 cm away from the base without lymphatic involvement
Indications for right hemicolectomy for appendiceal carcinoid tumor > 2 cm diameter, < 1 cm from base of appendix, lymphatic involvement
Treatment for bronchospasm in carcinoid ___________ Aprotinin
Intussusception in adults is concerning for ___________ Cancer
Most common benign small bowel tumor _______ Leiomyoma
Findings associated with Peutz-Jegher’s syndrome Jejunal and ileal hamartomas, melanotic skin pigmentation
Malignancy associated with celiac sprue _________ Lymphoma
Malignancy associated with small bowel leiomyoma ______________ Leimyosarcoma
Most common malignant small bowel tumor Duodenal adenocarcinoma
Treatment for most common malignant small bowel tumor _________ Whipple
Treatment for parastomal hernia ___________ Relocation
Organism most commonly infecting stomas __________ Candida
Cause of diversion colitis Decreased short chain fatty acids in a Hartmann’s pouch
Treatment for diversion colitis ____________ SCFA enemas
CT findings consistent with appendicitis Wall > 2 mm thick or diameter > 7 mm, fat stranding
Most likely location for inflamed appendix to perforate Midpoint of the antimesenteric border
Most common cause of appendicitis in adults __________ Fecalith
Most common cause of acute abdominal pain in the first trimester of pregnancy __________ Appendicitis
Most common trimester for acute appendicitis to occur during pregnancy ________ Second
Most likely trimester during pregnancy for acute appendicitis to perforate ________ Third
Mortality rate for babies in utero after the mother’s appendix ruptures 35%
Skin finding with typhoid enteritis ___________ Maculopapular rash
Treatment for typhoid enteritis ___________ Bactrim
Created by: StudyBug82