Term
| Crohns diseasi is found most commonly in what part of the GI tract |
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Definition
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Term
| Describe the flow chart of Crohns as it progresses |
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Definition
| Aphous ulcers --> Fissures--> "Cobblestone" appearance--> Transmural--> Thickening, Narrowing of the lumen |
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Term
| Describe the Sx of crohns |
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Definition
| Abdominal pain (most common), Diarrhea (2nd most common, usually following meals, no blood/mucus/pus), Weight loss (later, poor absorption), Perianal ds (anal fissures), Fever, Anemia (usually Fe, or megaloblastic caused by B12 or folate def.), |
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Term
| What term descibes crohns when viewing an xray |
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Definition
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Term
| what are three patterns of crohns ds behavior |
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Definition
| Stricturing, Perforating, Inflammatory |
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Term
| What is the preferred surgical tx of crohns |
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Definition
Stricturoplasty: open bowel with a longitudinal incision and closing with a transverse[image] |
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Term
| T/F Crohns ds is 60-300x more often develop CA |
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Definition
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Term
| What is the most common reason Crohns patients need surgery |
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Definition
| Obstruction, fistula, and abscess |
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Term
| True / False Meckels Divertic is the most common congenital anomaly of the GI tract |
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Definition
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Term
| List the "Rule of 2" in Meckel's Divertic |
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Definition
- 2% of the population
- 2x more common in males
- 2 feet proximal to ileocecal valve
- 2 types of mucosa usually
- 2% affected pop become symptomatic
- Sx usually occur within first 2 years of life
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Term
| Why is Meckles Divertic considered a true diverticulum? |
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Definition
| B/c is contains all walls of the bowel |
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Term
| Where is meckles normaly at? |
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Definition
| Antimesenteric border or terminal ileum, 45-90cm proximal to ileocecal valve |
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Term
| What is the most common sx of meckles divertic? |
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Definition
| Bleeding from an ulceration surrounding ileum secondary to acid secretion from heterotropic gastric tissue |
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Term
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Definition
A Meckels scan is used to look for the presence of gastric mucosa in the intestine. Uses 99m Tc pertechnetate, Radioisotope absorbed by the gastric mucosa,90% diag accuracy in patients with Meckel related hemorrhage
[image] [image][image] |
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Term
| What are the tree most common benign small intestine tumors? |
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Definition
- Leiomyoma (GIST)
- Adenoma
- Lipoma
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Term
| 5 important things about Leiomyoma? |
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Definition
- Can be intramural/extramural
- Can cause obstruction
- Bleeding is the most common complication
- Difficult to determine malignant potential
- Surgical resection
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Term
| Where is the most common area in the small intestine for Lipoma tumor |
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Definition
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Term
| Dx or Lipoma can be seen by CT scan because of what? |
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Definition
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Term
| What are the three types of Adenoma in the Small intestine? |
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Definition
- Tubular: Likely pedunculated, low malignant
- Villous: Higher malignant pot. if >2cm
- Brunner Gland:Hyperplastic exocrine glands, no malignant pot.
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Term
| What is the Tx of choice for Tubular and Brunner Gland Adenoma's |
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Definition
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Term
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Definition
- Rare AD
- Benign multiple intestinal polyps
- Pigmented lesions of buccal mucosa, lips, nose, palms, and soles
- Anemia present
- "Clean Sweep" approach to avoid repeat surgery
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Term
| What are the most common sx of benign small intestine tumors |
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Definition
- >50% are assymptomatic
- Bleeding10%
- Obstruction 20%
- Pain 20-30%
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Term
| What is the dx study done by visualizing the bowel and shooting dye into the stomach? |
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Definition
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Term
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Definition
| Looking for additional lesions when in the bowel |
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Term
What are the most common malignant Small intestine tumors? |
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Definition
- Adenocarcinoma 30-50%
- Carcinoid 25%
- Lymphoma 15%
- Sarcoma 10%
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Term
| What is the biggest risk factor for Adenocarcinoma of the Small intestine? |
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Definition
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Term
| What are most common sx of Lymphoma in the small intestine? |
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Definition
| abd pain, malaise, and weight loss |
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Term
| Tx options for Malignancy? |
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Definition
- Wide resection of the regional lymph nodes
- if mets-->palliative surgery
- Chemo, XRT
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Term
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Definition
Poor average 5 year survival is : - Adeno: 25%
- Sarcoma: 30-40%
- Lymphoma 20-50%
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Term
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Definition
- Collection from each hepatic segment
- Coalesce into the right and left Hepatic ducts
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Term
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Definition
| Junction of right and left Hepatic ducts |
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Term
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Definition
- reservoir for bile
- pear shaped
- 30-50 ml
- Fundus --bulbous end
- Infundibulum -- narrow end, cystic duct arises
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Term
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Definition
| Dilatation in of the infundibulum in diseased states |
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Term
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Definition
- connect gb to the common duct
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Term
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Definition
| Spiral crescentic folds in epithelial lining |
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Term
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Definition
- Junction of Cystic Duct and common Hepatic duct to duodenal lumen
- 6mm in dia.
- Enters the 2nd portion of duodenum
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Term
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Definition
| also called the hepatopancreatic sphincter or Glisson's sphincter, controls secretions from the liver, pancreas, and gallbladder into the duodenum of the small intestine. It is a sphincter muscle located at the surface of the duodenum. It appears slightly distal to the joining of the common bile duct and pancreatic duct as they enter the descending duodenum and forms from the ampulla of Vater. |
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Term
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Definition
| is formed by the union of the pancreatic duct and the common bile duct. |
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Term
| What is the arterial blood supply to the Gallbladder? |
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Definition
| Cystic Artery -- it is a branch of the right hepatic artery |
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Term
| what is th aterial supply to the biliary ducts? |
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Definition
| A small unnamed branch of the hepatic artery and small retroperitoneal arteries |
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Term
| What is the Venous drainage of the Gall bladder? |
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Definition
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Term
| What is the lymphatic drainage of the Biliary system? |
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Definition
- Cystic duct node
- Portal Nodes
- Nodes around pylorus, left gastric artery, and head of pancreas
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Term
| Enteric Nervous System does what (3 things) |
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Definition
- Influenced by PNS and SNS
- Refex control of the GB and Spincter fx
- Pain from biliary tract
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Term
| What three anatomical landmarks are in the Hepatocystic triangle? |
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Definition
- Cystic Artery
- Right Hepatic Artery
- Cystic Duct
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Term
| Porta Hepatis is known as what two names? |
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Definition
| Hepatocystic Triangle and Triangle of Calot |
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Term
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Definition
Contains: - Extrahepatic biliary ducts
- Hepatic Artery
- Portal Vein
- Forament of winslow
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Term
| What is the pringle maneuver? |
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Definition
| clamping the hepatic artery and portal vein to stop bleeding |
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Term
| What does the Biliary system do |
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Definition
- Forms bile
- metabolizes bile
- metabolizes bilirubin
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Term
| What regulates the Biliary System? |
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Definition
- CCK
- Vagal cholinergic fibers
- Somatostatin inhibitory
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Term
| List two types of congenital GB lesions |
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Definition
|
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Term
| list two types of congenital bile duct lesions |
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Definition
- Hypoplastic
- Cystic
- Choledochal cysts
- Caroli's ds
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Term
| List 6 risk factors for Cholelithiasis |
|
Definition
- Adult female pima indian
- Female
- Fat
- Fertile
- Over Forty
- Fair skin
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Term
| What are the 4 types of Gallstones? |
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Definition
- Cholesterol (mixed) stones
- Pigment stones
- Black
- Brown
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Term
| what are three factors of the development of cholestrerol stones? |
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Definition
- Supersaturation of cholesterol
- Nucleating event
- Incomplete GB emptying
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Term
|
Definition
| recurrent attacks of the RUQ or epigastric pain following a heavy meal |
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Term
| What is the best method of Dx for Biliary colic? |
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Definition
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Term
| Acute calculus cholecystitis pathophys |
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Definition
Obstruction of cystic duct --> GB continues to make mucous --> Distention --> Venous congestion -->Arterial compromise --> ISCHEMIA 75% BACTERIAL superinfection |
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Term
|
Definition
- Empyema
- Perforation
- Fistulization
- Hydrops
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Term
|
Definition
- acute, gradual RUQ pain, fever, N/V
- may have right shoulder pain
- similar to biliary colic but pain then worsens
- Murphy's Sign
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Term
|
Definition
| Inspiratory arrest with RUQ pain |
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Term
| What labs are elevated in AC |
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Definition
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Term
| If cannot dx with certainty what else can be done to R/O AC |
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Definition
99mTc-HIDA scan (DISIDA scan); highly sensitive, considered dx of AC if nonfilling of GB is demonstrated
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Term
| How do you diff Biliary Colic from AC |
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Definition
- Biliary colic
- usually nontender, has resolving pain, no fever, no leukocytosis
- AC
- Leukocytosis, very painful, N/V
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Term
| why is it important to perform an early lap chole (1-7 days after onset of sx)? |
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Definition
| Seems to have a more favorable outcome than delayed cholecystectomy, also, there is less incidence of conversion to open chole. |
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Term
| When is an assymptomatic gallstone indicated for surgery? |
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Definition
- Native american indian
- high incidence of gallstone related CA
- Large Stones >2cm
- Porcelain gallbladder
- Hemoglobinopathies
- Heart/Lung transplant
- Long-term TPN
- Bariatrics (gastric bypass)
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Term
| When is is safe to do a cholecystectomy during preg? |
|
Definition
| During the second tri or postpartum |
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Term
| If a cholecystectomy is performed during the 3rd tri what is the preterm labor percentage? |
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Definition
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Term
|
Definition
| Intestinal obstruction caused by large gallstone impacted in the intestinal lumen |
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Term
| What is it called when you have a gallstone ileus on xray? |
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Definition
| Pneumobilia: air in the gall bladder |
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Term
|
Definition
| common hepatic duct obst caused by compression from a stone impacted in the cystic duct |
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Term
| How is Mirizzi Syndrome dx? |
|
Definition
|
|
Term
| Acute Acacalculus Cholecystitis |
|
Definition
- seen in patients that are hospitalized for a long time
- Usually secondary to chemical damage from bile stasis and ischemia of gallbladder wall
- GB wall thickens
- Sludge develops
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|
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Term
|
Definition
- Percutaneous cholecystostomy
- Cholecystectomy
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Term
| Infundibulum of the Gallbladder |
|
Definition
| Narrow end of which the cystic duct arises |
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