Term
| what part of duod are RP? |
|
Definition
| 2nd and 3rd (desc and transverse) |
|
|
Term
| what is NOT maximally absorbed in the jejunum? |
|
Definition
FE (duod)
Bile (non conj @ ileum, conj @ TI)
B-12 (TI)
Folate (TI) |
|
|
Term
|
Definition
SB 3 cm
Tverse colon 6 cm
Cecum 9 cm |
|
|
Term
|
Definition
1 = rest
2 = accel and GB contraction
3 = peristalsis
4 = deceleration |
|
|
Term
| motilin role in peristalsis? |
|
Definition
|
|
Term
|
Definition
| blocks serotonin receptors in brain |
|
|
Term
|
Definition
| secretion of alkaline solution in duod |
|
|
Term
|
Definition
| release anti-microbials when exposed to bacterial antigens |
|
|
Term
Peyers patches
-aka
-where in highest conc?
-types? |
|
Definition
-aka GALT (gut assoc lymphoid tissue)
-highest in Ileum
-B cell vs T cell vs macrophages/dendritic |
|
|
Term
|
Definition
specialized endothelium covering peyers patches.
-sample antigen and present them to APCs in PPatches. |
|
|
Term
|
Definition
Noon: Go-lytely
1/3/5 pm: neo and erythro
8 pm + am before surg: fleets
-cefoxitin pre-op |
|
|
Term
|
Definition
endoscopy w/bx
-inc lymphoid elements, villous atropy, enlarged crypts, loss of arch |
|
|
Term
|
Definition
1. endoscopy w/bx
2. Serology (anti-transglutamase Ab)
*99% specific, 90% sensitive* |
|
|
Term
|
Definition
|
|
Term
|
Definition
anal disease
-large skin tag
?? |
|
|
Term
|
Definition
intermitttent abd pain, D, weight loss
-mucous D (non-bloody) |
|
|
Term
|
Definition
**TI = MC location**
Small + large bowel = 50%
small only = 30%
large only - 20%
**anywhere from mouth to anus** |
|
|
Term
| % pts with Crohs DZ eventually needing operation? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Crohns colonoscopy findings? |
|
Definition
non-friable mucosa
cobblestoning, skip lesions,
transmural inflammation
aphthous ulcers, long fissures |
|
|
Term
| how does enteroclysis work? |
|
Definition
| fluoro-->finds strictures |
|
|
Term
Crohns DZ
-tx of stable DZ |
|
Definition
1. 5 ASA (enema vs left sided dz)
2. azathi or 6 mercaptopurine
3. +/- loperamide
4. low residual diet |
|
|
Term
Crohns DZ
-EC fistula medical tx |
|
Definition
1.Colovesicule + ECF-->Add infliximab + flagyl
2. Perianal, anorectal-vaginal fistula-->
inflix + flagyl + ciproflox |
|
|
Term
|
Definition
| irreversible peripheral neuropathy in 50% |
|
|
Term
| role of Budesonine in Crohns DZ tx? |
|
Definition
-Use as steroid for exacerbation of ISOLATED ilio-cecal dz
*benefit = dec systemic absorption* |
|
|
Term
Crohns DZ-
-exacerbation mgmt |
|
Definition
-add flagyl +/- cipro
-add steroids (100 q8 hydrocort)
-add inflix if severe
-consider TPN for fistula closure
**NO loperamide, NO NSAIDs** |
|
|
Term
| meds to avoid in exacerbation of Crohns DZ |
|
Definition
|
|
Term
Crohns DZ
-indications for surgery w/exacerbation? |
|
Definition
1. inc WBC
2. persistent tachy
3. worsening exam
4. sepsis
5. bloody BM >6-12 /day |
|
|
Term
Crohns DZ
-options for use of different 5 ASA compounds? |
|
Definition
1. Pentasa = SI + Colon
2. Mesalazine = TI and colon
3. Sulfasalazine = Colon only |
|
|
Term
Crohns DZ
-general surgical indications |
|
Definition
1. failed med tx/chronic steroids
2. obstruction (usually ok w/meds. give it 3-5 days) |
|
|
Term
|
Definition
NO LATERAL INTERNAL SPHINCTEROPLASTY in CD PTS
-tx sitz, lido jelly, stool softeners, NGT cream vs chronic fissure |
|
|
Term
Crohns DZ
-hemorrhoids/peri-anal skin tags mgmt |
|
Definition
|
|
Term
| meds for per-anal/anorectal-vag fistula with CDz? |
|
Definition
continue maintenance
add inflix
add flagyl..AND cipro |
|
|
Term
anorectal vag fistula w/CDz
-surg options |
|
Definition
1. low fistula-->rectal advancement flap
2. high fistula-->resect bowel/reanast..close vag defect..omental interposition..temp diverting ileostomy |
|
|
Term
Crohns perianal fistula
-best dx studies? |
|
Definition
|
|
Term
Crohns perianal fistula
-initial tx |
|
Definition
1. unroof it, open the tract
2. drain any internal abscess
3. maintenance + inflix + cipro/flag x 3wk |
|
|
Term
Crohns perianal fistula
-definition of simple vs complex |
|
Definition
| simple = internal opening below dentate line |
|
|
Term
Crohns refractory perianal fistula
-simple fistula tx |
|
Definition
1. Seton thru fistula x 6-8 wks-->then remove, close opening, curettage out the tract
**don't sequentially tighten it due to risk of incontinence** |
|
|
Term
crohns refractory complex perianal fistula
-tx |
|
Definition
1. rectal avancement flap (CI if active mucosal inflammation)
2. APR w/colostomy (if severe and above is CI) |
|
|
Term
Crohns enterovesicle fistula
-best test |
|
Definition
|
|
Term
Crohns enterovesicle fistula
-tx |
|
Definition
1. maintenance + inflix + flagyl
**surg if failed after 6-8 wks** |
|
|
Term
| indication for early surg w/entero-vesicle fistula? |
|
Definition
repeated UTIs
-otherwise try conserv. mgmt x 6-8 wks |
|
|
Term
| Operative findings of CD = |
|
Definition
Creeping fat,
Skip lesions
Transmural inflamm
Cobble stoning
Fistulas |
|
|
Term
| difference in location between CD and UC? |
|
Definition
CD usually spares rectum
*UC does not* |
|
|
Term
| margins for CD bowel resection? |
|
Definition
just need to be 2 cm from GROSS disease
**don't need neg micro margins** |
|
|
Term
| surg option for diffuse CD of colon/rectum? |
|
Definition
proctocolectomy + ileostomy
**NO ILEO-ANAL ANAST**
**NO J POUCH W/CD** |
|
|
Term
|
Definition
-1st/2nd seg: GJ + vagotomy (avoid marginal ulcer)
-3rd/4th seg: Duodeno-J **NO WHIPS** |
|
|
Term
CD stricturoplasty
-when indicated
-recurrence rate? |
|
Definition
-consider @ multiple strictures to save SB length
-50% recurrence rate requiring surg
**10% leak, abscess, fistula rate** |
|
|
Term
| Complications after TI resection? |
|
Definition
1. megaloblastic anemia (dec B12/folate)
2. Gstones, osmotic D (dec bile reab)
3. steaorrhea (dec fat uptake)
4. Ca-Ox kidney stones (dec oxalate binding to Ca 2/2 ???) |
|
|
Term
|
Definition
| Pts with Crohns pan-colitis are at same risk as UC |
|
|
Term
|
Definition
duod > jej> ileal
**70% @ 2nd portion duod, MC w/in 2 cm of ampulla** |
|
|
Term
juxta-amp duodenal divertic
-tx |
|
Definition
1. if enough space between tic and ampulla...intraluminal rsxn w/primary closure
2. if not enough space for primary closure..hepatico-J vs biliary obstruction +/- ERCP w/stent if panc obstruction |
|
|
Term
|
Definition
FRIENDS
Foreign body--Radiation--Inflam bowel dz--Epithelialization--neoplasia--distal obstruction--sepsis/infxn |
|
|
Term
|
Definition
1. 6 weeks conservative mgmt, +- NPO/TPN if > 200 cc/day.
2. after 6 wk: fistulogram, UGI/sbft etc..
3. re-op = fistula takedown w/primary reanast +/- diversion |
|
|
Term
SBO cuases
-MC w/out hx surg vs w/surg |
|
Definition
1. without
-SB = hernia
-LB = CA
2. with
SB= adhesions
LB= CA |
|
|
Term
| % cure rate vs SBO with conservative mgmt? |
|
Definition
80% of partials
20% of complete |
|
|
Term
Ovarian CA causing SBO
-mgmt |
|
Definition
DEBULK it
-improves XRT outcomes |
|
|
Term
|
Definition
young pt w/weight loss, bilious E,
-better when prone |
|
|
Term
|
Definition
total body cast
prolonged recumbency
spinal rods |
|
|
Term
|
Definition
|
|
Term
| When not to place perm mesh vs ventral hernia? |
|
Definition
-s/p enterotomy or rsxn
-->use vicryl...allow granuation..then graft |
|
|
Term
| % of carcinoid tumors causing carcinoid syndrome? |
|
Definition
|
|
Term
Carcinoid tumor
-best dx test for detecting vs localizing |
|
Definition
1. octreotide scan = best for localization if not seen on CT
2. Chromogranin A = best for detecting |
|
|
Term
|
Definition
1.CT/octreotide scan
2.Urine 5 HIAA
3. Chromogranin A (best for detecting) |
|
|
Term
|
Definition
appendix (50% of all carcinoids, but only 2% are malig)
-next = ileum, rectum |
|
|
Term
|
Definition
|
|
Term
Carcinoid tumor
-site that leads to highest rate of carcinoid syndrome? |
|
Definition
ileum
-35% malig
-20% carcinoid syndrome |
|
|
Term
SB Carcinoid tumor
-risk of other tumors? |
|
Definition
-10% are multiple
-20% have unrelated 2nd GI CA
**look around** |
|
|
Term
Carcinoid Syndrome
-Sxs (MC?) |
|
Definition
| -flushing (MC), D, bronchoCONSTRICTION, Right heart lesions, |
|
|
Term
| site of Carcinoid tumor w/lowest incidence of carcinoid syndrome? |
|
Definition
| rectal and bronchial carcinoids |
|
|
Term
|
Definition
1.Kulchitsky cells (neural crest) produce serotonin, bradyK, kallikrein, chromogranin2
2. Serotonin = Diarrhea
3. tryptophan deficiency (sero precursor) = pallagra (Diarrhea, dermatitis, dementia) |
|
|
Term
| what carcinoid products cause which sxs? |
|
Definition
1. Serotonin (trp deficiency) = pallagra
-dermatitis/dementia/diarrhea
2. bradyK = hypoTN (vasodilator)
3. Kallikrein = flushing |
|
|
Term
| what causes inc carcinoid syndrome sxs? |
|
Definition
|
|
Term
Carcinoid tumor
-surg tx options |
|
Definition
1. @ appendix..
a. <2 cm, no base involved, no mets = appy
b. > 2 cm, +base or mets = right hemi
2. anywhere else (except rectum)
= tx like CA (seg rsxn + lymphadenectomy)
3. Debulk +/- chole if liver met rsxn |
|
|
Term
|
Definition
1. octreotide vs syndrome/mets
-2nd line = interferon
2. streptozocin, 5FU vs mets |
|
|
Term
Carcinoid tumor
-tx of flushing? |
|
Definition
| alpha blockers (phenothiazine, cyproheptadine) |
|
|
Term
Carcinoid tumor w/mets
5YSR |
|
Definition
|
|
Term
|
Definition
leiomyoma
-usually extra-luminal |
|
|
Term
|
Definition
ileum
-resect it to ro CA |
|
|
Term
MC malig SB tumor =
-MC location |
|
Definition
adenoCA-
MC duod (40%-->70% of which are 2nd portion)
-MC originate in ampulla |
|
|
Term
| MC benign vs malig SB tumors? |
|
Definition
|
|
Term
|
Definition
FAP
Gardners
Polyps/adenomas |
|
|
Term
| Tx duod adenoCA based on location |
|
Definition
a. @ 1st/2nd portion -->WHIPPLE
b. @ 3/4 portion ==>rsxn w/duodeno-J |
|
|
Term
SB Leiomyosarcoma
-MC location
-ddx vs benign tumor?
-tx |
|
Definition
-Jej/Ileum, MC extraluminal
- > 5 mitoses/HPF, atypia, necrosis
-resection (no adenectomy since its sarcoma) |
|
|
Term
SB Lymphoma
-MC location / cell type
- |
|
Definition
Ileum (inc Pyers patches)
B cell |
|
|
Term
|
Definition
SBO
*if post TXP-->inc risk bleeding/perf* |
|
|
Term
|
Definition
| Wegeners, SLE, AIDS, Crohns, Celiac, TXP |
|
|
Term
| SB lymphoma tx based on location |
|
Definition
1. duod, anal, panc, thyroid:
-C-XRT
2. Il/jej, colon (MC cecum):
en block + nodes f/b CXRT
3. Gastric: surg if stg 1, otherwise CXRT
4. splenic: splenectomy vs chemo vs WW |
|
|
Term
Peutz Jeghers
-transmission ?
-sxs |
|
Definition
1. AD
2. mucocut. melanotic skin pig. freckles.
GI hamartomatous polyps-->pw obstruction
**first pres often intussusception** |
|
|
Term
|
Definition
|
|
Term
Peutz=Jeghers
-what CA are increased? |
|
Definition
1. extra-intestinal malig
*MC CA = breast*
2. only minimal inc intestinal malig
3. NO significant inc colon CA risk |
|
|
Term
Peutz=Jeghers
-mean survival |
|
Definition
|
|
Term
Peutz=Jeghers
-screening regimen |
|
Definition
1. yearly.. EGD/Cscope, RUQ US, pap/vag exams, testicular US, breast exams @ 20, Mammo @ 25.
2. q2 UGI/SBFT |
|
|
Term
|
Definition
EGD w/rigid overtube to prevent coiling in stomach
-gets further down SB, uses 200 cm scope |
|
|
Term
Peutz-Jeghers
-indication for polyp removal |
|
Definition
any bigger than 5 cm
hemorrhagic
CA risk |
|
|
Term
| MCC adult intussusception = |
|
Definition
cecal adenoCA
-always worry about CA w/adult intuss.
**70 have tumor lead point** |
|
|
Term
adult intussusception
mgmt |
|
Definition
-NO barium enema reduction
-->OR for resection
**MCC = cecal adenoCA, and 70% have tumor lead point** |
|
|
Term
| cm of SB needed to survive? |
|
Definition
75 cm
*50 w.competent IC valve |
|
|
Term
|
Definition
radiolabeled B12 given PO followed by normal B12 IM injection (to saturate liver B12 receptors)
-thus if absorbed from gut, the radiolabeled B12--->urine
-if < 10 % excreted in urine..+ve for perncious anemia |
|
|
Term
High output fistulas
-MC location |
|
Definition
proximally (duod or jej)
**colonic usually low and more likely to close on its own** |
|
|
Term
pt w/EC fistula and persistent fever..
-concern/work-up? |
|
Definition
check for abscesses
-fistulogram, CT, UGI/SBFT |
|
|
Term
| ostomy w/highest parastomal hernia rate? |
|
Definition
|
|
Term
| obstruction rate w/loop ileostomy? |
|
Definition
|
|
Term
| PPhys diversion colitis ? |
|
Definition
Dec short chain FA
-tx SCFA enema |
|
|
Term
|
Definition
ischemia
-can dilate if mild |
|
|
Term
|
Definition
|
|
Term
| stoma w/inc risk of stones? |
|
Definition
ileostomy
-inc GB and uric acid kidney stones |
|
|
Term
Post-op ostomy w/duskiness..
mgmt? |
|
Definition
if dark below level of fascia-->re-op
-if ok @ level of fascia..NTD |
|
|
Term
| order of sxs with appendicitis? |
|
Definition
1. anorexia
2. pain
3. vomiting |
|
|
Term
|
Definition
diameter > 7 mm
thickness > 2 mm |
|
|
Term
Appy
-other tests for females? |
|
Definition
-b-HCG
-pelvic exam, U/S vs CT |
|
|
Term
| MC location of appy perf? |
|
Definition
| mid-point of anti-mesenteric border |
|
|
Term
|
Definition
lymph node hyperplasia
-often s/p viral illness |
|
|
Term
|
Definition
|
|
Term
| when NOT to operate on appy? |
|
Definition
walled off, perf'd appy
-perc drain
-interval appy
*f/u barium enema/scope to RO perf colon CA* |
|
|
Term
| pt with necrotic base after appy.. |
|
Definition
|
|
Term
MC timing of preg appy..
-to occur
-to perf |
|
Definition
-MC to occur @ 2nd trimester-
-MC to perf @ 3rd trimester-
** appy is MCC acute abd pain in 2st tri** |
|
|
Term
|
Definition
if open procedure..
-incision where pt is having pain
*superior displacement due to uterus* |
|
|
Term
| MC location of 3rd trimester appy pain? |
|
Definition
RUQ pain
-worse lying on right side |
|
|
Term
| % fetal mortality with appy rupture? |
|
Definition
|
|
Term
| MCC death w/pseudomyxoma peritonei = |
|
Definition
|
|
Term
appendix mucocele
-surg mgmt? |
|
Definition
1. benign (mucinous cystadenoma)-> Appy
2. malig (mucinous cystadenoCA)-> R-hemi |
|
|
Term
pseudomyoxma peritonei
-definition |
|
Definition
| rupture of malignant appendiceal mucinous cyst-adenoCA |
|
|
Term
| what infectious organisms can cause ileitis? |
|
Definition
| yersinia, campylobacter, salmonella |
|
|
Term
Terminal regional ileitis
-% that is actually crohns? |
|
Definition
|
|
Term
Typhoid enteritis
-tx/cause
-sxs |
|
Definition
Salmonella --> tx w/Bactrim
p/w fever/HA, mac-pap rash, leukopenia, constipation |
|
|
