-
Portion of duodenum with 90% of ulcers
1st
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Portion of duodenum with ampulla of Vater and duct of Santorini
2nd
-
Retroperitoneal portions of duodenum (2)
Descending and transverse (2nd and 3rd)
-
Blood supply of duodenum
GDA, pancreaticoduodenals
- Portion of small bowel where maximal absorption occurs
- Jejunum
-
Portion of small bowel with long vasa recta and circular muscular folds
Jejunum
-
Vascular supply to jejunum
SMA
-
Portion of small bowel with short vasa recta
Ileum
-
GI cells that secrete mucin
Goblet cells
-
GI cells that contain secretory granules and enzymes
Paneth cells
-
GI cells that release 5-hydroxytryptamine
Enterochromaffin cells
-
GI cells with alkaline solution
Brunner�s glands
-
Lymphoid tissue in GI tract, particularly in ileum
Peyer�s patches
-
Antigen-preserving cells in the intestinal wall
M cells
-
Most important hormone in migrating motor complex (MMC)
Motilin
-
Conglomerations of TAGs, phospholipid, cholesterol and protein; released into lymphatics
Chylomicrons
-
Primary bile acids (2)
Cholic, chenodeoxycholic
-
Secondary bile acids (2)
Deoxycholic, lithocolic
-
Test to check for B12 absorption (via radiolabeled B12 in urine)
Schilling test
-
Amount of small bowel needed to survive off of TPN
75cm (50 cm if ileocecal valve competent)
-
causes of nonhealing fistulas (7)
foreign body, radiation, inflammatory bowel disease, epithelialization, neoplasm, distal obstruction, sepsis/infection
-
% of fistulas that close spontaneously
40
-
common causes of SBO
hernia, adhesions, cancer
-
% of SBO that are successfully treated conservatively
80
-
air in biliary tree + SBO = ?
gallstone ileus
-
Meckel�s diverticulum: true or false diverticulum?
True
-
Cause of meckel�s diverticulum
Failure of closure of omphalomesenteric duct
-
Most common ectopic tissue found in Meckel�s
Pancreas
-
Most common presentation of Meckel�s in adults
Obstruction
-
From most to least common, order of diverticula in each portion of small bowel
Duodenal > jejunal > ileal
-
First peak of Crohn�s incidence (ages)
15-35
-
extraintestinal manifestations of Crohn�s disease
arthritis, arthralgia, pyoderma gangrenosum, erythema nodosum, ocular diseases, growth failure, megaloblastic anemia
-
most common anal symptom in Crohns
anal skin tags
-
diagnostic techniques for Crohns
colonoscopy + biopsy, enteroclysis
-
pathologic findings in Crohn�s
transmural, skip lesions, cobblestoning, narrow deep ulcers, creeping fat
-
medical treatments of Crohns (6)
5-ASA, sulfasalazine, steroids, azathioprine, methotrexate, remicade
-
% of Crohns patients who eventually need an operation
90
-
surgical indications for Crohns (5)
obstruction, abscess, megacolon, hemorrhage, anarectalvaginal fistulas
-
complications from removal of terminal ileum
dec B12 uptake, dec bile salt uptake, dec oxalate binding
-
cell types that produce serotonin
Kulchitsky cells
-
Breakdown product of seratonin that can be measured in urine
5-HIAA
-
precursor of serotonin
tryptophan
-
intermittent flushing and diarrhea caused by bulky liver mets
carcinoid syndrome
-
study to localize carcinoid tumor not seen on CT scan
octreotide scan
-
most common site for carcinoid tumor
appendix
-
treatment of appendiceal cardinoid
appendectomy (if <2cm), right hemicolectomy (if >2cm)
-
medical treatment for carcinoid (3)
streptozocin, 5FU, octreotide
-
treatment of flushing associated with carcinoid syndrome
alpha blockers
-
treatment of bronchospasm in carcinoid syndrome
aprotinin
-
most common benign small bowel tumor
leiomyoma
-
benign tumors of small bowel that most commonly occur in ileum
adenoma
-
genetic syndrome causing jejunal and ileal hamartomas, mucocutaneous melanotic skin pigmentation
Peutz-Jeghers syndrome
-
Most common malignant small bowel tumor
Adenocarcinoma
-
Most common portion of small bowel to have adenocarcinoma
Duodenum
-
Area of small bowel that most leiomyosarcomas occur
Jejunum, ileum
-
Area of small bowel that most lymphomas occur
Ileum
-
Most common subtype of lymphoma that occurs in small bowel
NHL B cell type
-
Patients predisposed to bowel lymphoma (6)
Wegeners, SLE, Crohns, sprue, AIDS, post-transplantation
-
Obstruction rate in loop ileostomies
1-2%
-
most common stomal infection
candida
-
decrease in short chain fatty acids in Hartmann�s pouch
diversion colitis
-
treatment of diversion colitis
short chain fatty acid enemas
-
most common cause of stomal stenosis
ischemia
-
most common cause of fistula near stoma site
Crohns disease
-
Findings on CT scan consistent with appendicitis
Diameter >7mm, wall thickness >2mm, fat stranding, no contrast in appendiceal lumen
-
Most likely area appendix perforates
Midpoint of antimesenteric border
-
Most common cause of appendicitis in children
Hyperplasia
-
Causes of appendicitis
Hyperplasia, facalith, cancer
-
Treatment of walled-off perforated abscess
Perc drainage, interval appy
-
Most common cause of acute abdominal pain in 1st trimester
Appendicitis
-
Trimester when appendix is most likely to rupture (in pregnancy)
3rd
-
% fetal mortality when appendix ruptures during pregnancy
35
-
causes of ileus (6)
surgery, electrolyte abnormalities, peritonitis, ischemia, trauma, drugs
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