SI

Question 1

most frequently encountered surgical disorder of the SI

Answer 1

Mechanical small bowel obstruction

Question 2

epidemiology of SBO

Answer 2

1. intraabdominal adhesions
2. hernia
3. Chron’s dse
4. neoplasms
5. SMA syndrome, volvulus, intussussption, foreign bodies

Question 3

signs of intestinal obstruction

Answer 3

Colicky abdominal pain, N/V, Abdominal distention, Obstipation, scar

Question 4

Triad of SBO (xray)

Answer 4

dilated small bowel
air fluid levels
paucity of air in the colon

Question 5

Xray positions in SBO

Answer 5

upright chest
upright abdomen
supine abdomen

Question 6

Closed loop obstruction

Answer 6

U shape or C shape dilated bowel loops

radial distribution of mesenteric vessels -> torsion point

Question 7

Strangulation (TPPMP)

Answer 7

thickening of bowel walls
pneumatosis interstinalis
portal venous gas
mesenteric haziness
poor uptake of IV contrast

Question 8

contrast used in SBO CT scan

Answer 8

oral water-soluble contrast

Question 9

limitation of CT scan in SBO

Answer 9

low sensitivity (patrial small bowel obstr)

Question 10

used in cases of partial small bowel obstruction

Answer 10

Small bowel series / enteroclysis

Question 11

conservative management of SBO

Answer 11

IVF, antibiotics, bowel rest, NGT for decomperssion

Question 12

Conditions treated with condservative therapy as initil tx

Answer 12

Partial obstruction
Complete obstruction
Carcinomatosis
Obstruction in early postop

Question 13

what to check for viability in Surgery

Answer 13

normal color(pink)
peristalisis
marginal arterial pulsations

Question 14

What to use when i doubt to check for pulsatile mass

Answer 14

doppler probe

Question 15

what to use to verify arterial perfusion

Answer 15

IV fluorescein fye

Question 16

which part of the SI is affected in Chron’s

Answer 16

Distal ileum

Question 17

risk factors for Chron’s dse

Answer 17

smoking, female, high socioeconomic status, genetics

Question 18

what gene increase risk for chron’s dse

Answer 18

NOD 2 on chromosome 16 / IBDI locus

Question 19

what layer is affected in Chron’s

Answer 19

All layers

Question 20

leads to adhesion, strictures, fistulas and abscesses

Answer 20

serosal inflammation

Question 21

earliest lesion in Chroh’s

Answer 21

Aphthous ulcer, halo of erythema

coalace -> cobblestone appearance

Question 22

characteristic of chrohn’s

Answer 22

noncesating granuloma

Question 23

pathognomonic for chron’s

Answer 23

fat wrapping

Question 24

discontinuous portions of si

Answer 24

skip lesions

Question 25

Main diagnostic tool for Crohn's

Answer 25

Colonoscopy - ulcerations - cobble stone with skip lesions

Question 26

crohn's: ASCTA_ and pANCA _ | Ulcerative colitis ASCA _ and PANCA _

Answer 26

C: +,- U: -,+

Question 27

T/F. there is a cure for crohn's

Answer 27

F. no cure so palliative cure

Question 28

Active dse in Crohn's

Answer 28

Thickening fo bowel wall and mesentery Narrowing of lumen serosal inflammation and covered with fat

Question 29

procedure of choice for Crohn's

Answer 29

Segmental resection with end to end anastonosis

Question 30

For short stricture (<12cm)

Answer 30

Heinecke-Mlikulicz

Question 31

for long stricture (25cm)

Answer 31

Finney

Question 32

T/F. Appendectomy is done even if appx is normal

Answer 32

True

Question 33

Definition of fistula

Answer 33

Abnormal connection or communication bet two epithelialized hollow surface or organs

Question 34

factors that hinder closure (Friends)

Answer 34

``` Foreign body w/in tract Radiation enteritis Inflammation/infection Epithelialization Neoplasm Distal obstruction of small bowel SHort fistuolous tract ```

Question 35

most useful initial test for stable px

Answer 35

CT scan

Question 36

Small bowel series (3)

Answer 36

if CT scan failed to show fistula site of origin of fistula r/o distal intestinal obstruction

Question 37

most common benign neoplasm of the small intestine

Answer 37

Adenoma 1. tubular (leat agg) 2. tubulovillous 3. villous- most aggressive

Question 38

most common mesenchymal tumor arising fro the small intestine

Answer 38

gastrointestinal stromal tumor | - interstitial cells of cajal

Question 39

most common extranodal form of lymphoma

Answer 39

primary GI lymphoma - lymphocytes ileum

Question 40

treatment of small bowel neoplasm

Answer 40

resection

Question 41

Therapies for adenoma

Answer 41

<1: endoscopically >2, transduodenal polypectomy or segmental duodenal resection 2nd portion: pancrearicoduodenectomy/whiples

Question 42

induces cellular injury directly and thru generation of free radicals

Answer 42

radiation enteritis - great impact on rapidly proliferating cells -dose: 4500 Effects potentiated by chemotherapeutic drugs - methotrexate, doxorubicin, 5-fluorocil,catinomycin D

Question 43

T/F. Chronic mucosa only, acute all layers

Answer 43

F.

Question 44

Acute radiation enteritis

Answer 44

mucosa only | villus blunting, leukocytes, plasma cells in crypt

Question 45

Chronic radiation enteritis

Answer 45

occlusion vasculutus chronic ischemia terminal ileum diag: ELECTROLYSIS

Question 46

gold standard diagnostic of meckel's diverticulum

Answer 46

Radionuclide scans (Tc-pertechnetate) scintigraphy