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