Fiser ABSITE Ch. 35 Small Intestine Flashcards Preview

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Flashcards in Fiser ABSITE Ch. 35 Small Intestine Deck (35):
1

Function of: Small intestine? Large intestine?

Nutrient and water absorption; Water absorption

2

Duodenum anatomy: -Retroperitoneal portions? -Vascular supply?

-2nd and 3rd -Superior (off GDA) and inferior (off SMA) pancreaticoduodenal arteries

3

Jejunum: -Anatomy? -Function?

-100 cm long, long vasa recta, supplied by SMA -90% of water, 95% NaCl absorption

4

Ileum: -Anatomy -Function

-150 cm, short vasa recta, SMA supply -B12, folate and bile acid absorption

5

Short gut syndrome: -Diagnostic tests -Treatment

-Sudan red (fecal fat) -Schilling test (radiolabeled B12) -Fat restriction, PPI, lomotil

6

How much small bowel needed to survive with TPN in short gut?

75 cm or 50 cm with competent ileocecal valve; Meckel's diverticulum (rule of 2's)//2 FEET from ileocecal valve; 2 years old; 2% of population; 2 types of tissue (pancreatic, gastric)

7

How does Meckel's present?

Bleeding in children. Obstruction in adults.

8

Segmental resection in Meckel's?

-Neck > 1/3 of luminal diameter -Complicated diverticulitis -Diverticulitis involves base

9

Perianal disease in Crohn's:

-First presentation in 5% -Presents as SKIN TAGS -Treat with FLAGYL

10

Medical treatment of Crohn's

-Loperamide and 5-ASA -Steroids for acute flares -anti-TNF-alpha inhibitors for steroid-resistant or fistulas; 90% will need surgery

11

What cell type produces serotonin?

Kulchitsky (enterochromaffin) cells

12

Serotonin metabolism

Part of the amine precursor uptake decarboxylase (APUD) system. 5-HIAA is a breakdown product that can be measured in urine.

13

Carcinoid tumors release:

#NAME?

14

Symptoms of carcinoid syndrome and treatment:

#NAME?

15

Detection and localization of carcinoid?

Detect - Chromogranin A level; Localize - Octreotide scan

16

Small bowel carcinoid

Increased risk of MULTIPLE primaries and second unrelated malignancies

17

Carcinoid treatment

Depends on location: -Appendix:

18

Peutz-Jeghers syndrome

#NAME?

19

Risk factors for duodenal adenocarcinoma

-FAP -Gardner's -von Recklinghausen -polyps -adenomas

20

Leiomyosarcoma location

Extraluminal jejunum and ileum

21

Small bowel lymphoma

-Ileum -Associated with: Wegener's, AIDS, celiac sprue, SLE, Crohn's -NHL B cell type -Wide en bloc resection, NO WHIPPLE

22

Most common stomal infection?

Candida

23

Treatment of diversion colitis (Hartmann's pouchitis)?

Short chain fatty acid enemas

24

Most common cause of stoma stenosis?

Ischemia

25

Most common cause of fistula near stoma site?

Crohn's

26

Ileostomy increases risk of?

Gallstone; Uric acid kidney stones

27

Most common cause of appendicitis?

Hyperplasia - children; Fecalith - adults

28

Mucous papillary tumor of appendix

Appendix mucocele - should open to not spill contents - can get PSEUDOMYXOMA PERITONEI with rupture - SBO from peritoneal tumor spread MCC of death

29

Causative organism in typhoid

Salmonella

30

Treatment of typhoid enteritis

Bactrim

31

Symptoms of typhoid

#NAME?

32

SMA eventually branches into?

Ileocolic artery

33

Intestinal brush border

Maltase, Sucrase, Limit dextrinase, Lactase

34

Cell types of small bowel: Absorptive cells

Goblet (mucin), Paneth (secretory granules, enzymes), Enterochromaffin (APUD, 5-HT release), Brunner's glands (alkaline solution), M cells (APCs), Peyer's patches

35

Migrating motor complex

Phase I - rest, Phase II - acceleration and gallbladder contraction, Phase III - peristalsis (motilin acts now), Phase IV - deceleration