-
maximum site of water absorption
jejunum
-
phases of MMC
- I-rest
- II- acceleration, GB contraction
- III-peristalsis
- IV deceleration
-
motilin acts on what phase
III
-
cell types of intestinal mucosa
goblet, enterochromaffin, absorptive, brunners glands, paneth, M cells
-
what helps paneth cells fight off infection
anti-defensins, lysozyme, phospholipase A2
-
best test to diagnose celiac sprue
biopsy
-
biopsy of celiac sprue looks like what
increased lymphoid elements, villous atrophy, enlarged crypts of lieberkuhn, loss of small bowel architexture
-
other diagnostic test
anti-transglutamase
-
best dx test for crohns
tissue biopsy
-
colonoscopic signs of crohns
cobblestoning, apthous ulcers, long deep fissures
-
in suspected crohns what do you need to r/o
infectious source so get stool cxs, ova parasites c diff toxin
-
medical tx of crohns fistulas
infliximab + flagyl; if anal/rectal or vaginal add cipro
-
long term use of flagyl can cause
peripheral neuropathy
-
avoid what drugs with acute exacerbations of crohns
NSAIDS and loperamide
-
5-ASA compound only usefull in colon
sulfasalazine
-
avoid what in anal fissures in a pt with crohns
lateral internal sphincterotomy
-
often initial presenting symptom of crohns
perianal fistula
-
refractory complex perianal fistula
rectal advancement flap if mucosa not involved with active crohns disease
-
initial treatment for all perianal fistulas
- define with MRI or EUS
- unroof
- drain any abscesses
- infliximab
- cipro/flagyl for 3 weeks
-
always r/o what with fistulas
abscess and distal obstruction
-
-
diffuse crohns disease of colon and rectum
proctocolectomy with ileostomy- no ileoanal anastomosis or j pouch
-
surgical management of crohns disease of duodenum
- 1st and 2nd portion- gastroJ with vagotomy
- 3rd and 4th duodenoJ
- can do stricturoplasty if just a short stricture is present
-
problemes with severe crohns of terminal ileum or with resection
megaloblastic anemia, steatorrhea (bile salt), gallstones, kidney stones
-
most common location of duodenal diverticula
within 2 cm of ampulla
-
with duodenal diverticula you need to r/o
gallbladder disease
-
tx of duodenal diverticula
can observe unless perforation, bleeding, obstruction, or highly symptomatic
-
r/o what in enterocutaneous fistulas
- F oreign body
- R adiation
- I nflammatory bowel disease
- E epithelialization
- N eoplasia
- D istal obstruction
- S epsis/infxn/abscess
-
how long do you wait for conservative therapy for fistulas
6 weeks
-
most common cause of large bowel obstruction in a patient with previous surgery
cancer
-
sxs improve in Wilkie disease in what position
prone
-
tests to diagnose carcinoid
- octreotide scan
- urine 5-HIAA
- chromagranin A
-
highest sens for detecting carcinoid
chromagranin A
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