Small Intestines (Dra. Turingan)

Question 1

The duodenum is demarcated from the stomach by the _____ and is demarcated from the jejunum by the__________

Answer 1

from stomach- pyrlorus, from jejunum- ligament of Treitz

Question 2

Charcteristic of Jejunum

Answer 2

thinner mesenteric fat but LONGER VASA RECTA

Question 3

Characteris tic of ILEUM

Answer 3

FATTY mesenteric fat

Question 4

located at the base of the crypt, contain secretory granules growth factors, digestive enzymes, antimicrobial peptides

Answer 4

Paneth Cells

Question 5

At what layer is the Myenteric or Auerbach Plexus located?

Answer 5

Muscularis Propria

Question 6

The mucosa of the small intestines is further divided into what layers?

Answer 6

1.Muscularis Propria, 2. Lamina porpria, 3. epitheliallayer

Question 7

What is the total Small intestine ABSORPTION?

Answer 7

7500ML/ 7.5 L

Question 8

TOTAL LARGE intestine EXCRETION

Answer 8

1500mL /1.5L

Question 9

total intake/secretion enetering and leaving the Small intestinal lumen

Answer 9

9000mL/ 9L

Question 10

Describe the motility of the outer longitudinal layer of the SI

Answer 10

bowel shortening

Question 11

describe the motility of the inner circular layer of the SI

Answer 11

luminal NARROWING

Question 12

Common etiology of EXTRINSIC causes of SBO

Answer 12

Adhesions (iatrogenic)

Question 13

3 etiologies of SBO

Answer 13

INtraluminal, intramural, extrinsic

Question 14

2 intramural causes of SBO

Answer 14

Crohn’s, tumors

Question 15

What are the 3 ABD series radiograph to be ordered

Answer 15

ABD in supine, in upright and CHEST In upright

Question 16

What are the most specific findings for SBO? the triad with 70-80% sensitivity

Answer 16

1. dilated small bowel loops (>3cm), 2. Air fluid levels on upright fiilms, 3. Paucity of air in the colom

Question 17

What is your next MGT in patient with intestinal ishemia not improved after surgery?

Answer 17

2nd look operation

Question 18

What are the cornerstones of Adhesion prevention?

Answer 18

good surgical technique, careful handling of tissue, minimal use and exposure of peritoneum to foreign bodies.

Question 19

Name intraoperative measures to reduce postOP ILEUS

Answer 19

minimize bowel handling, lap approach, avoid exintraop fluid administration

Question 20

Name POSToperative measures to reduce postOP ILEUS

Answer 20

Early enteral feeding, epidural anes(if indicated), avoid excess IV administration, correct electrolyte abnormalities, consider mu opiod antagonist

Question 21

Management of fistulas

Answer 21

(immunomodulators)azathioprine, (monoclonal antibody)infliximab. NO ANTIBIOTICS!

Question 22

pANCA (-), ASCA (+), diagnosis?

Answer 22

Crohn’s disease (opposite pANCA (+), ASCA (-)-ulcerative colitis)

Question 23

If the fistula tract is <2cm it will positively impact the enteric fistula closure. T/F

Answer 23

FALSE, the longer (>2cm) a fistula, the more likely it will close

Question 24

T/F >50% of intesinal fistula close spontaneously

Answer 24

TRUE

Question 25

Factors that prevent closure of Intestinal fistulas

Answer 25

FRIENDS. Foreign body w/n tract, Radiation enteritis, INfection, Epithelialization of tract, Neoplasm fistula origin, Distal obstruction of the intestine

Question 26

MGT for periampullary multiple sessile tumors

Answer 26

Pancreaticoduodenectomy

Question 27

MGT for carcinoid tumors

Answer 27

Segmental intestinal resetion + regional lymphadenectomy, highest survival rate (75-95%, 5 yrs SR)

Question 28

treatment for Intestinal lymphoma

Answer 28

segmental resection + adjacent mesentery

Question 29

treatment for GIST

Answer 29

SMALL-segemental resection , METASTATIC-chemo/palliative/bypass

Question 30

Goal of surgery for Chronic radiation enteritis

Answer 30

limited resection of diseases intestine, primary anatomosis between healthy bowel segments

Question 31

describe Meckel’s

Answer 31

2% prevalence 2:1, male, 2 ft proximal to the ileocecal valve in adults, 1//2 symptomatic <2y/o

Question 32

MGT for asymptomatic acquired diverticulitis

Answer 32

NONE

Question 33

MGT for symptomatic Meckel’s

Answer 33

Diverticulotomy, removal of bands

Question 34

1st line, 2nd line Dx for persistent MILD bleeding and MGT

Answer 34

1st push and capsule enteroscopy, 2nd 99m Tc-labeled RBC scan, MGT-angiography

Question 35

Most common etiology of SI perforation

Answer 35

duodenal perforation during ERCP