Small Intestines Disease

Question 1

***what are the reasons for low incidence of small bowel adenocarcinoma?

Answer 1

1-low amount of fluid, alkali & bacteria in the small intestines

2-passage is fast

3-rapid life cycle of cells

4-protective apoptotic mechanism in the small intestine wall; high igA lvl in the wall

Question 2

Where are the adenocarcinoma most commonly found?

Answer 2

Proximal small intestines (2nd part of duodenum)

Question 3

Where are the other malignant lesions (carcinoid tumor, lymphoma, or GIST) most commonly found?

Answer 3

Distal small intestine

Question 4

What are the branches of the celiac artery?

Answer 4

-Splenic a.
-Left gastric a.
-Common hepatic a.

Question 5

Which nerve plexus is found in the muscularis propria?

Answer 5

Myenteric (Auerbach’s ) plexus

Question 6

Which plexus is found in the submucosa

Answer 6

Meissner’s plexus

Question 7

The duodenum has no ……… and bcz of that it is considered ……..?

Answer 7

No mesentery
partially Retroperitoneal

Question 8

where’s peyer’s patch found?

Answer 8

submucosa

Question 9

what are the gold standard diagnostic methods in SMALL BOWEL TUMORS?

Answer 9

capsule enteroscopy(small intest) and double balloon endoscopy(whole GIS)

Question 10

what are the symptoms of small intestine neoplasms

Answer 10

abdominal pain
obstruction
constipation

Question 11

what is the most common benign vs malignant small intestine tumor?

Answer 11

benign: adenoma
malignant: adenocarcinoma

Question 12

in small intestine, villous adenomas are rare and most commonly found in the duodenum and is associated with ………..?

Answer 12

familial polyposis syndrome

Question 13

which neoplasms are premalignant lesions in small intestines and must be removed?

Answer 13

villous and true adenomas

Question 14

Lipomas are most common in the ………. of the small intestines?

Answer 14

ileum

Question 15

which type of polyp in the small intest is a component of Peutz-jeghers syndrome(colon dis) ?

Answer 15

hamartomatous polyp

Question 16

in which type of neoplasm is there a *risk of malignancy due to the presence of adenomatous polyps in small intestines?

Answer 16

hamartomatous polyp

Question 17

what is the most common symptom in hamartomatous polyp?

Answer 17

recurrent colic abdominal pain due to intussusception

Question 18

which type of small intest tumor is
-found in jejunum
-common symptom is bleeding
-found in Osler-weber-rendu syndrome

Answer 18

hemangiomas

Question 19

diagnostic method for hemangiomas?

Answer 19

angiography

Question 20

what are the 2 most common symptoms of small intestine malignant tumor?

Answer 20

1-partial small bowel obstruction
2-painless bleeding

Question 21

which one is more common in small intestine tumors; metastatic or primary tumors?

Answer 21

metastatic>

Question 22

if a patient has crohn’s , where can the adenocarcinomas be found?

Answer 22

ileum (usually in the duodenum)

Question 23

do adenocarcinomas have poor or high prognosis?

Answer 23

poor prognosis

Question 24

whipple procedure is performed in patients with?

Answer 24

adenocarcinoma

Question 25

what is the tx for adenocarcinoma?

Answer 25

colon resection

Question 26

*** which tumor originates from Cajal cells(*mesenchymal cells located within the muscle layers of the alimentary tract that mediate communication between the *autonomic nervous system and smooth muscle)?

Answer 26

Gastrointestinal stromal tumors GIST

Question 27

the defining feature of GIST is the expression of .......?

Answer 27

tyrosine kinase KIT receptor

Question 28

**which small intestine neoplasm causes lymph node metastasis?

Answer 28

adenocarcinoma s.a diffuse gastric ca (unlike GIST**)

Question 29

what are the 2 drugs used to treat GIST?

Answer 29

Imatinib(adjuvant therapy; Treatment given after the main treatment to reduce the chance of cancer coming back by destroying any remaining cancer cells) & Sunitinib(in case of resistance to imatinib)

Question 30

chemotherapy has no proven efficacy in tx of .........

Answer 30

adenocarcinoma

Question 31

***which tumor originates from enterochromaffin (neuroendocrine)cells?

Answer 31

carcinoid tumors

Question 32

***what does the carcinoid tumor secrete?

Answer 32

serotonin, substance P, and histamine

Question 33

70% of the time appendiceal carcinoid tumors are ......

Answer 33

solitary(single)

Question 34

3 places in GIS Where carcinoid tumors can be found?

Answer 34

1-appendix(solitary) 2-small intestine(multiple) 3-rectum

Question 35

in which part of the GIST is the tumor size imp?

Answer 35

in the small intestine (not in colon)

Question 36

***tx for carcinoid tumor?

Answer 36

somatostatin receptor scintigraphy [ocreotide] (reduces the secretion of histamine, serotonin, and substance p)

Question 38

***In carcinoid syndrome patients with elevated CgA and …… together have a shorter survival rate?

Answer 38

NT-pro BNP

Question 39

Which method is not used for diagnosis of carcinoid tumor?

Answer 39

MR (used in dx of metastatic disease esp liver metastasis)

Question 40

Which drug is effective in palliating the symptoms of carcinoid syndrome?

Answer 40

Octreotide

Question 41

**which tumor originates from neuroendocrine cells?

Answer 41

Carcinoid tumor

Question 42

Most common small intest benign tumor symptom?

Answer 42

Bleeding &pain

Question 43

Most common small intest malignant tumor symptom?

Answer 43

Obstruction

Question 44

In carcinoid syndrome most patients have metastasis in which organ?

Answer 44

Liver metastasis bcz THEY BYPASS THE PORTAL VEIN AND VENA CAVA

Question 45

What are the most common symptoms of carcinoid syndrome?

Answer 45

Episodic flush, bronchospasm, diarrhea and vasomotor collapse attacks (Bcz of the serotonin, subs P, and histamine secretions )

Question 46

Which molecule’s level do you measure to know serotonin levels?

Answer 46

Circulating serotonin is metabolized in the liver to 5-hydroxyindolacetic acid (5-HIAA). The level of 5-HIAA in the urine can be measured.

Question 47

……….is the most common true diverticulum of the small intestine.

Answer 47

Meckel’s diverticulum

Question 48

……. diverticula of the small intestine are most often in the duodenum.

Answer 48

Acquired

Question 49

***what are the rule of 2’s in Meckel’s divertulum?

Answer 49

-in 2% of population -2 feet from ileocecal valve -2inches long - 2x common in men -2 genera of heterotopic (ectopic) tissues;stomach and pancreas -symptoms under 2 years of age

Question 50

Definition of short bowel syndrome?

Answer 50

Small intestine < 200 cm short bowel syndrome—> not enough intestinal length for feeding

Question 51

What are the causes of small bowel resection leading to short bowel syndrome?

Answer 51

-*Mesenteric vessel occlusion* -Crohn’s -mesenteric vascular injury

Question 52

What is the tx for short bowel syndrome?

Answer 52

Iv fluid

Question 53

What is stage 1 short bowel syndrome tx?

Answer 53

Fluid electrolyte therapy and TPN (total parenteral nutrition)

Question 54

At which stage of short bowel syndrome does anemia, hyperoxaluria, or hypomagnesemia, or gallstones/kidney stones ?

Answer 54

Stage 3

Question 55

At which stage of short bowel syndrome does intestinal adaptation begins?

Answer 55

Stage 2

Question 56

**Describe the treatment for short bowel syndrome?

Answer 56

Stage 1: Fluid-electrolyte therapy and TPN(Total parenteral nutrition) Stage2: TPN continues Stage3: Iron, vitamin B12, folate, magnesium and vitamin D are given in addition to the normal diet.