small intestine anatomy , function pathology.pptx

anatomy and surgical pathology of small intestine

1. Small intestine

2. crohn’s disease

3. Principles of management of Crohn’s disease (CD) Close liaison between physician and surgeon is crucial Medical therapy should always be considered as an alternative to surgery, although surgery should not be delayed when a clear indication for surgery exists Patients must be optimised as far as possible prior to surgery, and this may require preoperative total parenteral nutrition CD is a chronic relapsing disease with a high likelihood of reoperation; the surgeon must take every reasonable effort to preserve bowel length and sphincter function

4. ENDOSCOPIC DILATATION IN CROHN’S DISEASE

5. Indication of surgery

6. Small bowel neoplasm Most are benign

7. Peutz jeghers syndrom Multiple hamartomatous polyp Autosomal dominant Intusscuception, obstruction, bleeding Stk11 gene on chromosome 19 Increase chance of malignancy Polypectomy Resection of bowel

8. Small bowel malignancy Adenocarcinoma Carcinoid tumour Lymphoma GIST

9. Adenocarcinoma More in jejunum Crohns disease ,FAP, peutz jeghers, coeliac disease, hereditary non polyposis cancer Clinical presentation Resection of 5 cm bowel with mesentry

10. Carcinoid tumour More common appendix , Ileum and rectum 2percent appendectomy Lymphnode metastasis Vasoactive peptides 5-HT(serotonin), prostaglandins, histamine Liver metstasis carcinoid syndrome Octreotide scanning preoperatively Bowel and hepatic resection Somatostatin analogue to prevent carcinoid crisis Carcinoid syndrome ● Diarrhoea ● Bronchospasm ● Facial/upper chest flushing ● Palpitations ● Tricuspid regurgitation

11. lymphoma Mostly non Hodgkin B cell lymphoma T cell lymphoma in coeliac disease Mediterenean lymphoma Burkitts lymphoma ileo caecal regian Chemotherpy and some time surgery

12. GIST Mesenchymal tumour Difficult to distinguish between benign and malignant High Cd 117 level on histochemistry 50-70 age group neurofibromatois Radioresistant and not sensitive to conventional chemotherapy Imatinib tyrosine kinase inhibitor resection

13. Intestinal diverticulae Congenital or acquired Acquired More common in jejunum At mesenteric border Not contain muscularis Incidental or symptomatic

14. Congenital diverculae Meckels diverticulum Rule of 2 Asymptomatic or symptomatic Gastric colonic and pancreatic mucosa Inflammation , perforation d/d appendicitis , duodenal perforation Malaena Resection or wedge resection Littre s hernia

15. Vascular anomalies of intestine Acute meseteric vascular ischaemia Sma and its braches more commonly involved Embolectomy vascular graft in early cases Extensive resection in late presentation Short bowel syndrome

16. Chronic meseteric ischaemia Mesenteric angina Pain after 50-60 min of meal

17. stoma Temporary or permanent Loop or double barel

18. Enterocutaneous fistula High or low output S – control of sepsis and skin protection N – nutrion parenteral for few days A – anatomic assessment P – definitive planned surgery

19. Short bowel syndrom < 200 cm small bowel Ileum is more important for absorption Colon can adapt to some small bowel absorption Ileum loss lead to fat, fat soluble vitamin and B12 deficiency Anti diahheoal agent, external supplement Home parenteral Nutrition