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Fiser Absite > 35 - Small Intestine > Flashcards

35 - Small Intestine Flashcards

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1
Q

Portion of the duodenum containing ampulla of Vater and duct of Santorini

A

2nd (descending)

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2
Q

Retroperitoneal portions of the duodenum

A

2nd (descending)

3rd (transverse)

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3
Q

Transition point of 3rd and 4th parts of duodenum

A

Acute angle at aorta (posterior) and SMA (anterior)

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4
Q

Vascular supply of duodenum

A

Superior (off GDA) and inferior (off SMA) pancreaticoduodenal arteries

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5
Q

Length of jejunum

A

100cm

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6
Q

Maximum site of all intestinal absorption

A

Jejunum

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7
Q

Length of ileum

A

150cm

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8
Q

Vascular supply of jejunum and ileaum

A

SMA

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9
Q

Enzymes of the intestinal brush border cells (4)

A

Maltase
Sucrase
Dextrinase
Lactase

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10
Q

Intestinal cells that secrete mucin

A

Goblet cells

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11
Q

Intestinal cells that secrete secretory granules and enzymes

A

Paneth cells

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12
Q

Intestinal cells that secrete 5-hydroxytryptamine (5HT)

A

Enterochromaffin cells

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13
Q

Intestinal cells that secrete alkaline solution

A

Brunner’s glands

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14
Q

Intestinal cells that represent lymphoid tissue, increased in ileum

A

Peyer’s patches

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15
Q

Antigen presenting cell in intestinal wall

A

M-cells

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16
Q

Migrating motor complex for gut motility (4 phases)

A

Phase 1 - rest
Phase 2 - acceleration/gallbladder contraction
Phase 3 - Peristalsis
Phase 4 - Deceleration

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17
Q

Hormone acting on migrating motor complex and which phase does it act on

A

Motilin, phase 3 (peristalsis)

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18
Q

Percentage of bile salts/acid reabsorbed

A

95%

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19
Q

Where is non-conjugated and conjugated bile salts reabsorbed and which is passively vs actively reabsorbed

A

Non-conjugated (50% passive absorption) - 45% ileum, 5% colon
Conjugated (50% active absorption w/ Na/K ATPase) - 50% terminal ileum

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20
Q

Symptoms of short-gut syndrome (3)

A

steatorrhea, nutritional deficiency (B12) and weight loss

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21
Q

Check for fecal fat

A

Sudan Red Stain

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22
Q

Checks for B12 absorption (in urine)

A

Schilling test

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23
Q

Amount of bowel needed to survive without TPN

A

75cm (50cm w/ intact ileocecal valve)

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24
Q

Tx for short gut syndrome (3)

A

Fat restriction
PPI
Lomotil

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25
Steatorrhea is deficiency in
Fat soluble vitamins (ADEK) and essential amino acids
26
Non-healing fistula causes (FRIENDSS)
``` Foreign body Radiation Inflammatory bowel dz/Infection Epithelialization Neoplasm Distal obstruction Sepsis Steroids ```
27
MCC of small bowel obstruction without and with previous surgery respectively
Without surgery - hernia | With surgery - adhesion
28
MCC of large bowel obstruction without and with previous surgery respectively
Without surgery - cancer | With surgery - cancer
29
Signs of gallstone ileus (Rigler's triad)
Air in biliary tree Stone outside gallbladder on imaging Small bowel obstruction
30
SBO from gallstone usually in
Terminal ileum
31
Gallstone ileus caused by fistula btn
gallbladder and 2nd portion of duodenum
32
Meckel's diverticulum cause by
Failure of closure of omphalomesenteric duct
33
Types of tissues found in Meckel's and which is most common
Pancreatic (most common) and gastric (most likely symptomatic w/ bleeding)
34
Most common presentation of Meckel's in adults
Obstruction
35
Indication for segmental resection of Meckel's (3)
Complicated diverticulitis (perforated) Neck > 1/3 diameter of normal bowel lumen Diverticulitis involving the base
36
Rule of 2's of Meckel's diverticulum (name 4-6)
``` 2 ft from ileocecal valve 2% of population Within first 2 yrs of life w/ bleeding 2 types of mucosal tissues 2 times more common in males 2 inches long ```
37
Management of juxta-ampullary duodenal diverticula with biliary and pancreatic sxs
Biliary - Choledochojejunostomy | Pancreatic - ERCP with stent
38
Most common involved segment for Crohn's
Terminal ileum
39
Percentage for initial presentation of Crohn's (terminal ileum, small bowel only, colon only, perianal)
TI - 40% SB - 20% Colon - 35% Perianal - 5%
40
Medical tx for Crohn's (maintenance and acute flare)
Maintenance - Sulfasalazine and loperamide | Acute - Steroids
41
Medical tx for Crohn's fistulas or steroid-resistant
Remicade (Infliximab)
42
Percentage of Crohn's eventually needing operation
90%
43
Tx of abscess in Crohn's
Percutaneous drainage
44
Surgical margins for Crohn's resection
No clear margin, 2cm from gross dz
45
Serotonin produced by which intestinal cells
Enterochromaffin (Kulchitsky) cells
46
Breakdown product of serotonin, where can you measure it
5-HIAA, measured in urine
47
Hallmark sxs of carcinoid syndrome (2)
Flushing (kallikrein) | Diarrhea (Serotonin)
48
Cause of carcinoid syndrome
Bulky liver metastases
49
Best study for LOCALIZING carcinoid tumor not seen on CT
Octreotide scan
50
Highest sensitivity for DETECTING carcinoid tumor
Chromogranin A level
51
Most common site of carcinoid tumor
Appendix
52
Indication for appendectomy vs right hemicolectomy of appendix carcinoid
Appendectomy - <2cm and NOT involving base of appendix | R hemicolectomy - >/= 2cm OR involving base of appendix
53
Chemo regimen for unresectable carcinoid disease
5-FU and streptozocin
54
Tx for flushing carcinoid sx
Alpha-blockers (phenothiazine)
55
Can result in falsely elevated 5-HIAA levels
Fruits
56
Most common location of small bowel adenomas
Duodenum
57
Puetz-Jeghers syndrome method of inheritance
Autosomal dominant
58
Puetz-Jeghers syndrome most common extra intestinal malignancy
Breast Cancer
59
Most common MALIGNANT small bowel tumor
Adenocarcinoma
60
Highest proportion of small bowel adenocarcinoma
Duodenum
61
Pts needs a Whipple if adenocarcinoma involving this portion of duodenum
2nd (transverse)
62
Small bowel Leiomyosarcoma most common locations
Jejunum and ileum (most extraluminal)
63
Small bowel lymphoma most common location
Ileum
64
Cell type for small bowel lymphoma
Non-Hodgkin Lymphoma B cell type
65
Most common stoma infection cause
Candida
66
Cause of diversion colitis
Lack of short chain fatty acids (tx with SCFA enemas)
67
MCC of stomal stenosis
Ischemia
68
MCC of fistula near stoma site
Crohn's dz
69
Conditions ncreased in pts with ileostomy due to loss of bile salts and HCO3
Gallstones and Uric acid kidney stones
70
Area most likely to perforate in appendicitis
Midpoint of the antimesenteric border
71
MCC of appendicitis in children
Lymphoid hyperplasia
72
MMC appendicitis in adults
Fecalith
73
Most common associations of appendicitis and pregnancy in 1st, 2nd and 3rd trimesters
1st - MMC acute abd pain 2nd - period when appendicitis most often OCCURS 3rd - period when appendicitis most often PERFORATEA
74
MCC of death with appendix mucocele
SBO
75
Sx (6) and Tx for typhoin enteritis (salmonella)
Sx - RLQ pain, diarrhea, fever, maculopapular rash, leukopenia, large mesenteric lymph nodes Tx - Bactrim

Fiser Absite (14 decks)

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