Abnormalities in Small Intestine - NEET PG Surgery
Apr 10, 2023
The small intestine is a crucial part of the digestive system, responsible for most nutrient absorption from our food. As a result, small intestine disorders can lead to various health problems, including malabsorption syndromes, inflammatory bowel disease, and small bowel obstruction.
Understanding the anatomy, physiology, and surgical management of the small intestine is essential for the NEET PG exam, as it is a common site of disease and surgical intervention in the abdominal cavity.
A protrusion or bulging in the lower portion of the small intestine is known as a Meckel's diverticulum. The bulge is a remnant of the umbilical cord and is congenital (existing at birth). The most frequent gastrointestinal tract congenital abnormality is Meckel's diverticulum. In the general population, 2% to 3% of people have it. it is Caused by Persistent VID/OMD this is mainly Congenital. True Diverticulum ( it has both Mucosa and Submucosa Muscularis propria) it is Characterized by Rule of 2.
2 inches in length
Located 2 feet proximal to I/C Junction
Symptomatic patients: <2 years of age
Ectopic mucosa is Gastric> Pancreatic > Colonic
Most common symptom is bleeding which generally manifests as lower GI Bleeding. the Most common symptom in Adults is Abdominal pain
cramps and pain in the abdomen.
tenderness in the area of the abdominal button (navel).
Bowel obstruction refers to a blockage that prevents the passage of intestines' contents. Pain, bloating, diarrhea, constipation, and vomiting may result from this.
Diverticulitis (intestinal wall edema).
Diagnosis of Meckel's Diverticulum:
Scan with technetium: This test is a scan. Injections of radioactive technetium are administered. This material, which can be seen using a specialised the camera, is absorbed by stomach cells in the diverticulum.
A short, flexible tube with a camera on the end is introduced into the colon and rectum during a colonoscopy to check for obstructions and the source of bleeding.
Endoscopy using a wireless capsule: During this procedure, the patient ingests a tiny camera that can look for signs of bleeding in the small intestine. If your child is too young to swallow a tablet, you can give it to him or her while they are sleeping.
Most common complication in children: Bleeding
Most common complication in Adult: Intestinal obstructions
Diagnosis: Investigation of choice for diagnosis: Tc-Pertechnnate scan
Treatment: Meckel's with Healthy base: Diverticulectomy
Meckel's with unhealthy base: RIA → Resection and anastomosis
Increased risk of complications:
Ectopic gastric mucosa
Superior Mesenteric Artery Syndrome/ Wilk’s Syndrome/ Cast Syndrome
It is Characterized by compression of 3rd part of duodenum by superior mesenteric artery the Predisposing factors for this condition are:
Rapid Weight loss
Rapid gain of height
Postprandial Abdominal Pain
Treatment of choice: Duodenojejunostomy
Most common organism which causes gastrointestinal tuberculosis is Mycobacterium tuberculosis. First organ to be infected is lungs and there is production of Infected sputum and then it affects the leum. Earliest lesion seen in Submucosa Most common site is Ileum and ileocolic junction.
Sclerotic fibrotic (30%)
TB: Transverse ulcers → healing causes stricture
In Typhoid there is Longitudinal ulcers
Nonspecific sign and symptoms
Most common symptom is Abdominal pain
Most common presentation is SAID (Subacute intestinal obstruction)
Investigation of choice - diagnosis: Most common lab abnormality: increased ESR (90%)
Initial investigation used for localization and staging → SRS
SRS (Somatostatin Receptor Scintigraphy)
Best Investigation for localizing: DOPA-PET
Plasma Chromogranin A, highly specific for Carcinoid Tumor
Segmental Resection + En bloc Lymphadenectomy
D - Dacarbazine
E – Epirubicin
F - 5-Fluorouracil
Carcinoid Tumor has better prognosis than Adenocarcinoma
SHORT BOWEL SYNDROME
Normal length of Small intestine: 600 cm
Short bowel < 200 cm
Causes (Massive Small intestine Resection)
Manifestations of SBS
Megaloblastic Anemia (Due to impaired B12 absorption)
Oxalate Renal Stones
Catabolism of gastrin Occurs in SI mucosa so in SBS there is "Hypergastrinemia"
TPN (Total Parenteral Nutrition)
Treatment of choice - Small Bowel Transplantation
BIANCHI procedure (LILT - Longitudinal intestinal Lengthening and Tailoring)
STEP (Serial Transverse Enteroplasty Procedure)
Previous Year Questions
Q. Which of the following is wrong regarding superior mesenteric artery syndrome? (AIIMS May 2018)
A. Superior mesenteric artery is compressed by third part of duodenum at the ligament of
B. Superior mesenteric artery has a normal angle between 38-65 degree is relation to duodenum
C. Strong procedure is corrective surgery in which ligament of Treitz is divided
D. Superior mesenteric artery syndrome is characterized by an angle less than 25 degree due to loss of intervening mescenteric pad of fat
Q. Which of the following is the most common epithelial tumor of stomach?(NEET Jan 2018)
A. Carcinoid tumor
D. Gastric adenocarcinoma
Q. Increased level of 5-HIAA is present in?(NEET Jan 2018)
C. Carcinoid tumor
Q. A 50 years old lady with history of carcinoid syndrome complains of flushing and diarrhea. Which of the following is not true regarding this syndrome? (JIPMER May 2019)
A. Occurs in <10% of carcinoid tumors
B. Octreotide injection reduces symptoms of flushing and diarrhea
C. Attacks precipitated by stress, alcohol and large meal
D. Bright-red patchy flushing is typically seen with ileal carcinoids
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