Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Small Bowel > Small Bowel > Flashcards

Small Bowel Flashcards

(70 cards)

Start Studying
1
Q

What is the most common causes of small bowel obstruction the US?

A

1) adhesions from prior surgery
2) hernia
3) neoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percent of patients who present with SBO will require a surgery during the index admission?

A

approx 25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the difference between open loop and closed loop bowel obstructions?

A

open loop obstructions are able to be decompressed via an NG tube; closed loop obstructions are closed at both the proximal and the distal ends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the electrolyte profile abnormality seen in any patient who has been vomiting for a significant time?

A

hypokalemic, hypochloremic metabolic alkalosis with a paradoxical aciduria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the indications for immediate surgery in a patient with a SBO?

A
  • peritonitis
  • evidence of bowel perforation
  • Closed loop obstructions
  • bowel strangulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What percent of patients with Crohn’s Disease will ultimate require an operation?

A

70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the macroscopic findings in Crohn’s Disease?

A
  • fat wrapping
  • aphthous ulcers
  • transmural inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 3 general “types” or categories of Crohn’s Disease?

A
  • fibrostenotic
  • inflammatory
  • penetrating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the effects of smoking on Crohn’s Disease?

A
  • higher incidence of fibrostenotic and penetrating types
  • worse perianal disease
  • high rates of surgery
  • high rates of post-surgical recurrence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the top down approach to Crohn’s Disease medications?

A

1) 5-ASA or sulfasalazine
2) Systemic steroids
3) Immunomodulators (azathiprine, 6-mercaptopurine, or methotrexate)
4) Biologics (Infliximab, adalimumab, cetrolizumab)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If a patient is on 5-ASA or sulfasalazine, when should these medications be stopped and started in regards to surgery?

A

they can be taken up to the day of surgery and restarted immediately after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the currently available biologics used in the treatment of Crohn’s Disease? How do they work?

A
  • infliximab (Remicade), Adalimumab (Humira), and certolizumab pegol ( Cimzia)
  • all inhibit TNF mediated inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common indication for surgery for Crohn’s Disease?

A

medically refractory disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What cancers are patients with Crohn’s Disease at increased risk for?

A
  • primary small bowel adenocarcinoma

- Colorectal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should always be performed in a patient with Crohn’s Disease that is undergoing a stricturoplasty?

A

a biopsy of the stricture because many times malignancy of the small bowel in the setting of Crohn’s Disease does not present with a mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the advantages of stricturoplasty compared to resection in Crohn’s Disease? Disadvantages?

A
  • Advantages: decreased recurrence rate, preserved bowel length, and possible restoration of function
  • Disadvantages: longer operative time, slightly increased risk of post-operative bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How would you surgically treat a symptomatic enteroenteric fistula in a Crohn’s Disease patient?

A

resection of the diseased segment of bowel with transverse closure of the innocent bystander segment of bowel. If the bystander segment does not appear to be healthy (inflammed, edematous, etc) or situated on the mesenteric side then resection should occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How would you surgically treat an enterovesicular fistual in Crohn’s Disease?

A

resection and primary anastomosis of the diseased bowel and oversew the bladder with an absorbable suture (vicryl) to avoid future stone formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would you surgically treat an enterovaginal or intrauterine fistula in Crohn’s Disease?

A

resection of the disease bowel with primary anastomosis. The uterus or vagina will often heal spontaneously after resection of the diseased bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the absolute contraindications to stricturoplasty in Crohn’s Disease?

A
  • perforation
  • Neoplasia
  • fistula
  • severe malnutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the relative contraindications to stricturoplasty in Crohn’s Disease?

A
  • Abscess

- Long, severely narrowed segments of bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What percent of patients with Crohn’s Disease who undergo a first operation will require a second operation?

A

approx 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the treatment of choice for symptomatic nonphlegmonous jejune-ileal Crohn’s Disease fibrotic strictures?

A

strictureplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When is strictureplasty contraindicated in Crohn’s Disease?

A
  • impaired nutritional status
  • Dyplasia or cancer at the stricture site
  • Localregional sepsis (abscess, phlegmon, peritonitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When should azathioprine be stopped when preparing a Crohn's Disease patient for the OR?
- it shouldn't be stopped. Azathioprine has no impact on post-operative morbidity and should be maintained through surgery
26
What is the main determinants in choosing between types of strictureplasty?
- length of stricture and number of strictures
27
Briefly describe the Heineke-Mikulicz strictureplasty? What length of stricture is ideal for this type of repair?
- a longitudinal incision is made on the anti mesenteric side of the bowel extending 2 cm proximal and distal to the stricture. The enterotomy is then close in a transverse fashion. - strictures
28
How does the Judd strictureplasty differ from the Heineke-Mikulicz strictureplasty?
The Judd strictureplasty is used when a fistula is present in the proposed site of the enterotomy. The enterotomy incorporates the fistula and then the bowel is closed the same as the Heineke-Mikulicz technique.
29
What technique can be used if the bowel proximal to a stricture is dilated?
The Moskel-Walske-Neumayer technique. Similar to the Heineke-Mikulicz technique, but the enterotomy is made with a Y shaped incision where the fork of the Y is pointing at the dilated end
30
Brief describe the Finney strictureplasty? What length stricture is ideal for this type of repair?
- The strictured bowel is folded over itself to form a loop at its midsection. A longitudinal enterotomy is performed halfway between the mesenteric and antimesentric borders. The opposing edges of the bowel are then sutured together in a side to side anisoperistaltic enteroenterostomy. - 7 cm to 15 cm
31
Briefly describe the Michelassi strictureplasty? What length stricture is ideal for this type of repair?
- The mesentery of the small bowel loop to undergo strictureplasty is divided at its midpoint. The proximal end of the loop is moved over the distal end in a side to side fashion. The two loops are approximated with Lembert sutures. Longitudinal enterotomies are made on both loops. The edges are the sutured together in a running fashion on the back wall and a Connell stitch on the front. Another layer of Lembert sutures are then placed on the anterior side. - > 15 cm
32
What is the most common primary malignancy of the small bowel?
Neuroendocrine tumors
33
Where is the most common location in the small bowel for neuroendocrine (carcinoids) tumors to occur?
ileum
34
What is carcinoid syndrome? What percentage of small bowel carcinoids cause this?
- Flushing (of the upper torso and face) and diarrhea due to secretion of metabolically undegraded vasoactive amino (specifically serotonin) in to the systemic circulation - Approximately 35%
35
What are the two biochemical tests used to diagnose carcinoid tumors?
- hydroxyindolacetic acid (5-HIAA) | - chromogranin A
36
What can cause false positive plasma levels of chromogranin-A?
PPIs
37
What is the treatment for small bowel neuroendocrine tumors (carcinoids)?
en bloc resection with extensive lymphadenectomy and wide resection of the mesentery - lymphadenectomy and resection of the mesentery because metastatic spread to the regional lymph nodes is common
38
What is a carcinoid crisis? How is it treated?
- excessive cutaneous flushing, hyperthermia, shock, arrhythmias, and bronchial obstruction - octreotide given routinely in the pre-operative period. Once it sets in you manage the symptoms
39
T/F: Small bowel GISTs tend to be more aggressive than gastric GISTs?
- true
40
What determines a low risk small bowel GIST?
41
What determines a moderate risk small bowel GIST?
5-10 cm and
42
What determines a high risk small bowel GIST?
> 5 cm and > 5 mitoses/50 HPF
43
What is the medical therapy available for treatment of GIST? How does it work?
- Imatinib | - Inhibits KIT, a tyrosine kinase receptor
44
What are the guideline for giving imatinib to patient with a GIST pre-operatively? Post-operatively?
- any patient who has borderline resectable disease or if decreasing tumor size will make surgery less extensive or easier - any patient with positive margins or residual disease, and any patient with a tumor > 3cm and negative margin
45
Where is the most common site of extra nodal lymphoma?
GI tract, specifically the ileum due to the high concentration of lymphoid tissue in the ileum
46
What bacteria is associated with mucosal-associated lymphoid tissue (MALT) type lymphoma?
H pylori
47
What is the most common type of malignancy of the small bowel?
metastases
48
What are the 3 common types of small bowel diverticula?
1. duodenal 2. Jejuno-ileal 3. Meckel's
49
Which types of small bowel diverticula are true diverticula? Which type are false diverticula?
- Meckel's diverticula is a true diverticula | - duodenal and jejuno-ileal diverticula are typically false
50
What is the cause of a Meckel's diverticula?
incomplete closure of the omphalomesenteric or vitelline duct during gestation
51
Where is the most common location for a duodenal diverticula?
2/3 are located in the periampullary region, mostly on the medial wall
52
What is the treatment for an asymptomatic duodenal diverticula?
nothing. Do not treat asymptomatic diverticula.
53
What is the first line treatment for symptomatic duodenal diverticula?
non-operative management with bowel rest, antibiotics, endoscopic or IR treatments
54
What are the indication(s) to operate on a symptomatic duodenal diverticula?
- emergent operation for bleeding or perforation | - failure of non-operative treatments
55
What is the first line treatment of symptomatic jejuno-ileal diverticula?
- medical with bowel rest, antibiotics, pain control
56
What are the indication(s) for operative intervention in jejune-ileal diveriticula?
- failure of medical management during symptomatic phase | - perforation in an unstable patient
57
When operative management is indicated for jejuno-ileal diverticula
removal of the offending part of the small bowel. Do not attempt to remove all diverticula
58
What is the most common congenital anomaly of the alimentary tract?
Meckel's diverticulum
59
What are the Meckel's diverticulum rule of 2's?
- found within 2 feet of the ileocecal valve - 2% of the population - 2 possible heterotopic tissues (gastric and pancreatic) - 2 x more common in males - 2% become symptomatic - Usually discovered within the first 2 years of life
60
What is the diagnostic test(s) if a Meckel's diverticulum is suspected?
- contrast enhanced CT | - technitium 99m pertechnetate scan which will concentrate in the etopic gastric tissue
61
What is the treatment for a symptomatic Meckel's diverticulum?
surgical excision; removal of the entire piece of small bowel not just the diverticulum
62
A symptomatic Meckel's diverticulum is virtually indistinguishable from what other common cause of acute abdominal pain?
acute appendicitis; in fact if a patient is taken to the OR for acute appendicitis and it is not found, one should run the terminal ileum looking for a Meckel's diverticulum
63
What is the management strategy for a Meckel's diverticulum found incidentally?
- in children remove it | - in adults leave it
64
How common is Roux stasis syndrome after Roux-en Y gastrojejunostomy? What is typically the cause?
- 25-30% | - a Roux limb > 40 cm
65
How is Roux stasis syndrome diagnosed?
clinically. It presents like gastroparesis in a patient after a Roux-en Y gastrojejunostomy
66
What are the treatment options for Roux stasis syndrome?
- Prokinetics, antiemetics, limiting narcotics | - Total gastrectomy in patients who do not improve with non-surgical methods
67
How common is post-vagotomy diarrhea after a vagotomy?
- 20%
68
How does post-vagotomy diarrhea present?
- diarrhea 30-60 minutes after a meal | - diarrhea can occur anytime and often patients have up to 20 watery stools per day, most not related to a meal
69
What is the treatment of post-vagotomy diarrhea?
- dietary modifications with more fiber - bulking agents - loperamide or codeine
70
What is the cutoff for post-operative ileus vs. prolonged post operative ileus?
post operative ileus lasts up to 5 days. When it lasts more than 5 days it is a prolonged post operative ileus

Small Bowel (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions