SB82 Small Bowel - Loosely taken from Fiser's ABSITE review
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| Location in the duodenum where 90% of ulcers occur ________ | Bulb
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| Which portions of the duodenum are retroperitoneal? | Descending and transverse
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| Normal length of jejunum | 100 cm
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| 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
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| Which part of the intestine re-absorbs non-conjugated versus conjugated bilirubin? | Non-conjugated – ileum; conjugated – terminal ileum
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| What substances are often deficient in terminal ileal resection? | B12, folate, bile acids
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| What percentage of the intestinal water is re-absorbed in the jejunum? | 90%
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| What is the normal length of ileum? | 150 cm
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| What is secreted by Brunner’s glands? | Alkaline mucus
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| Four phases of the MMC | Rest, acceleration/gallbladder contraction, peristalsis, deceleration
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| Most important hormone in the MMC | Motilin
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| 50% of bile acids are passively reabsorbed in these locations | Ileum and colon
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| 50% of bile acids are actively reabsorbed in the __________ | Terminal ileum
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| Diagnosis of short gut syndrome is made on the basis of what? | It is a clinical diagnosis, not based on length of gut
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| 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
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| How much gut do you need to survive off TPN, with and without a competent ileocecal valve? | 75 cm without, 50 cm with
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| How does gastric hypersecretion of acid interfere with fat absorption? | Decreased intestinal pH causes increased intestinal motility, interfering with fat absorption
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| “FRIENDS” of a fistula | Foreign body, Radiation, Inflammation (IBD), Epithelialization, Neoplasm, Distal obstruction, Sepsis/Infection
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| High-output fistulas are more likely in what location? _________ | Proximal bowel
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| Fistulas in what location are most likely to close? _________ | Colon
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| What percentage of fistulas close spontaneously? | 40%
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| Obstruction of small and large bowel without previous surgery (respectively) | Hernia, cancer
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| Obstruction of small and large bowel WITH previous surgery (respectively) | Adhesions, cancer
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| Conservative management (bowel rest, NPO, NG) cures what percentage of partial small bowel obstructions? | 80%
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| Conservative management (bowel rest, NPO, NG) cures what percentage of COMPLETE small bowel obstructions? | 20-40%
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| Definition of gallstone ileus | Small bowel obstruction from a gallstone obstruction the terminal ileum
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| Classic imaging found with gallstone ileus | Evidence of small bowel obstruction with air in the biliary tree
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| 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
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| Common facts about Meckel’s diverticulum | Within 2 feet of ileocecal valve, 2% of the population, presents in first 2 years of life
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| Cause of Meckel’s diverticulum | Failure of obliteration of the omphalomesenteric duct
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| Most common tissue type found within a Meckel’s diverticulum ___________ | Gastric
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| Indications for diverticulectomy of Meckel’s | Gastric mucosa inside (diverticulum feels thick) or has a very narrow neck
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| Indications for segmental resection of Meckel’s | Complicated diverticulitis, neck > 1/3 the diameter of the bowel lumen, diverticulitis involving the base
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| A patient presents with a duodenal diverticulum. What other condition should you rule out? ________________ | Chronic cholecystitis
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| Indications for surgical intervention for a duodenal diverticulum | Perforation, bleeding, obstruction, symptomatic
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| Normal age for first presentation of Crohn’s disease | 15-35 yo
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| Portion of the bowel most commonly involved in Crohn’s disease ___________ | Terminal ileum
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| Most common symptom of Crohn’s disease ________ | Anal skin tags
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| A patient with Crohn’s disease has an anal fissure. What treatment should you AVOID? ___________ | Lateral sphincterotomy
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| Treatment for incidental finding of IBD in a patient with suspected appendicitis | Remove appendix if cecum is not involved in inflammation
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| Cells that produce serotonin | Kulchitsky cells (aka enterochromaffin cells)
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| Substance to test for in urine with suspected carcinoid syndrome | 5-HIAA (breakdown product of serotonin)
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| Amino acid precursor to serotonin ___________ | Tryptophan
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| Tryptophan use can lead to this disease | Pellagra (diarrhea, dermatitis, dementia)
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| Hallmark symptoms of carcinoid syndrome | Flushing and diarrhea
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| 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)
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| The most common site for carcinoid tumors _____________ | Appendix
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| Indications for appendectomy for appendiceal carcinoid tumor | < 2cm diameter and > 1 cm away from the base without lymphatic involvement
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| Indications for right hemicolectomy for appendiceal carcinoid tumor | > 2 cm diameter, < 1 cm from base of appendix, lymphatic involvement
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| Treatment for bronchospasm in carcinoid ___________ | Aprotinin
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| Intussusception in adults is concerning for ___________ | Cancer
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| Most common benign small bowel tumor _______ | Leiomyoma
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| Findings associated with Peutz-Jegher’s syndrome | Jejunal and ileal hamartomas, melanotic skin pigmentation
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| Malignancy associated with celiac sprue _________ | Lymphoma
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| Malignancy associated with small bowel leiomyoma ______________ | Leimyosarcoma
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| Most common malignant small bowel tumor | Duodenal adenocarcinoma
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| Treatment for most common malignant small bowel tumor _________ | Whipple
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| Treatment for parastomal hernia ___________ | Relocation
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| Organism most commonly infecting stomas __________ | Candida
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| Cause of diversion colitis | Decreased short chain fatty acids in a Hartmann’s pouch
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| Treatment for diversion colitis ____________ | SCFA enemas
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| CT findings consistent with appendicitis | Wall > 2 mm thick or diameter > 7 mm, fat stranding
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| Most likely location for inflamed appendix to perforate | Midpoint of the antimesenteric border
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| Most common cause of appendicitis in adults __________ | Fecalith
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| Most common cause of acute abdominal pain in the first trimester of pregnancy __________ | Appendicitis
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| Most common trimester for acute appendicitis to occur during pregnancy ________ | Second
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| Most likely trimester during pregnancy for acute appendicitis to perforate ________ | Third
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| Mortality rate for babies in utero after the mother’s appendix ruptures | 35%
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| Skin finding with typhoid enteritis ___________ | Maculopapular rash
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| Treatment for typhoid enteritis ___________ | Bactrim
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