Duodenum

Crohn Disease of Duodenum

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Q) In Crohns  disease of duodenum , patient has a duodenal abscess which is  drained. He develops a fistula with  ileal communication. Surgery with the least chance of success would be

a. Ileal reaction and duodenal bypass

b. Ileal resection an dudodenal HMplasty
c. Ileal freshen and closure
d. Duodenum vertical closure

Hormones released from duodenum

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Hormone MCQ
Q. Which of the following hormones are not released in the duodenum?
a) Gastrin
b) Motilin
c) Somatostatin
d) Pancreatic YY
Correct Answer: d) Pancreatic YY

  • Gastrin – secreted mainly by G-cells in the stomach, and in small amounts from the duodenum.
  • Motilin – secreted by M cells in the duodenum and jejunum.
  • Somatostatin – secreted by D-cells throughout the GI tract, including the duodenum.
  • Pancreatic YY (PYY) – secreted by L-cells in the ileum and colon, not in the duodenum.
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Duodenal Adenocarcinoma

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Q) Which of the following is not true about duodenal adenocarcinoma

a) Adenocarcinoma is the most common malignancy affecting duodenum

b) Most of the patients with duodenal adenoacarcinoma have a palpable mass

c) Surgery is the main stay of management

d) GOO is the most common presentation

Duodenal Diverticula

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Which of the following statements about duodenal diverticula is incorrect?

a) Extraluminal diverticula are more common than intraluminal ones
b) They are most commonly located within 2 cm of the ampulla
c) The majority are symptomatic, presenting with epigastric pain
d) Diverticulectomy is the standard surgical treatment

Duodenal adenoma in FAP

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Q) What is the Surgery in FAP patient after colectomy for ampullary adenoma Stage IV

a)Classic Whipple
b) Pancreas preserving duodenectomy
c) Transduodenal excision
d) endoscopic excision

Answer is free for all

b) 

Duodenal cancers are the third most common (10%) cause of death in FAP after CRC and desmoid disease.

Duodenal adenomas  100% incidence

 tendency to progress to cancer.

The severity of duodenal adenomatosis predicts the chances of duodenal cancer,  Spigelman staging system that is based on

adenoma number, size, and histology

Patients with stage 0 disease (no adenomas) can be surveyed again in 5 years.

Stage I patients can be surveyed in 3 years;

stage II in 1 year;

stage III in 6 months

and stage IV is an indication to consider surgery. 36 % progress to cancer- Surgery is pancreas preserving duodenectomy

A Whipple is indicated for a duodenal cancer that is definitively operable

Duodenal adenomas can be treated by snare polypectomy or by transduodenal polypectomy. Ampullary adenomas can be treated by endoscopic mucosal resection or surgical ampullectomy

Ref schakelford page 1968