1. maximum site of water absorption
  2. phases of MMC
    • I-rest
    • II- acceleration, GB contraction
    • III-peristalsis
    • IV deceleration
  3. motilin acts on what phase
  4. cell types of intestinal mucosa
    goblet, enterochromaffin, absorptive, brunners glands, paneth, M cells
  5. what helps paneth cells fight off infection
    anti-defensins, lysozyme, phospholipase A2
  6. best test to diagnose celiac sprue
  7. biopsy of celiac sprue looks like what
    increased lymphoid elements, villous atrophy, enlarged crypts of lieberkuhn, loss of small bowel architexture
  8. other diagnostic test
  9. best dx test for crohns
    tissue biopsy
  10. colonoscopic signs of crohns
    cobblestoning, apthous ulcers, long deep fissures
  11. in suspected crohns what do you need to r/o
    infectious source so get stool cxs, ova parasites c diff toxin
  12. medical tx of crohns fistulas
    infliximab + flagyl; if anal/rectal or vaginal add cipro
  13. long term use of flagyl can cause
    peripheral neuropathy
  14. avoid what drugs with acute exacerbations of crohns
    NSAIDS and loperamide
  15. 5-ASA compound only usefull in colon
  16. avoid what in anal fissures in a pt with crohns
    lateral internal sphincterotomy
  17. often initial presenting symptom of crohns
    perianal fistula
  18. refractory complex perianal fistula
    rectal advancement flap if mucosa not involved with active crohns disease
  19. initial treatment for all perianal fistulas
    • define with MRI or EUS
    • unroof
    • drain any abscesses
    • infliximab
    • cipro/flagyl for 3 weeks
  20. always r/o what with fistulas
    abscess and distal obstruction
  21. margins for crohns
  22. diffuse crohns disease of colon and rectum
    proctocolectomy with ileostomy- no ileoanal anastomosis or j pouch
  23. 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
  24. problemes with severe crohns of terminal ileum or with resection
    megaloblastic anemia, steatorrhea (bile salt), gallstones, kidney stones
  25. most common location of duodenal diverticula
    within 2 cm of ampulla
  26. with duodenal diverticula you need to r/o
    gallbladder disease
  27. tx of duodenal diverticula
    can observe unless perforation, bleeding, obstruction, or highly symptomatic
  28. 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
  29. how long do you wait for conservative therapy for fistulas
    6 weeks
  30. most common cause of large bowel obstruction in a patient with previous surgery
  31. sxs improve in Wilkie disease in what position
  32. tests to diagnose carcinoid
    • octreotide scan
    • urine 5-HIAA
    • chromagranin A
  33. highest sens for detecting carcinoid
    chromagranin A
  34. sx of flushing in carcinoid syndrome caused by
  35. carcinoids found where rarely cause carcinoid syndrome
    rectal and bronchial
  36. most common site of carcinoid
  37. site with highest mets and carcinoid syndrome rate
  38. small bowel carcinoid is at risk of
    multiple sites and 2nd unrelated cancer
  39. medical treatment for carcinoids
    • octreotide
    • interferon if octreotide fails
    • alpha blockers like phenothiazine can help with flushing
  40. most common benign small bowel tumor
  41. surgery for duodenal adenocarcinoma of 3rd and 4th portion of duodenum
    resection with duodenojejunostomy
  42. differentiation between leiomyoma vs leiomyosarcoma
    >5 mitosis/hpf, atypia, necrosis
  43. when is surgery for lymphoma indicated
    3rd/4th portion of duodenum, ileum, jejunum, colon, gastric (stage I only), mariginal zone lymphoma of spleen
  44. type of surgery for bowel lymphoma
    wide resection with margins and lymph nodes + mesenteric, paraaortic LN sampling and liver biopsy
  45. 1st presentation of Peutz-Jeghers
  46. most common cancer with peutz jeghers
  47. tx of diversion colitis
    short chain fatty acid enemas
  48. most common cause of stoma stenosis
  49. treatment of typhoid enteritis
Card Set
small bowel