Jejunum

Small Bowel NET

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Q) 45 year old male with 2 cm Jejunal Neuroendocrine tumor ( NET).

Dota Scan Shows no metastasis What would be the best management in him?

a) Octreotide

b) Resection & Anastomoses of jejunum

c) Resection and Anastomoses with mesenteric excision

d) Radiotherapy

 

Small Bowel Adenocarcinoma & its Risk Factors

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Small Bowel Adenocarcinoma MCQ
Q) Which of the following is not a risk factor / least associated with small bowel adenocarcinoma?
a) Familial adenomatous polyposis (FAP)
b) Hereditary nonpolyposis colorectal cancer
c) Peutz-Jeghers syndrome
d) Juvenile polyposis coli
Correct Answer: d) Juvenile polyposis coli
Explanation: Juvenile Polyposis Coli is least associated with small bowel adenocarcinoma. Risk factors for Small Bowel Adenocarcinoma: 1. Hereditary polyps: - Familial adenomatous polyposis (FAP) - Hereditary nonpolyposis colorectal cancer - Peutz-Jeghers syndrome 2. Inflammatory and metabolic: - Crohn disease - Gluten-sensitive enteropathy (celiac sprue) - Prior peptic ulcer disease - Cystic fibrosis - Biliary diversion (e.g., previous cholecystectomy) 3. Lifestyle: - Smoking - Heavy alcohol use (>80 g/day ethanol) - Red meat/salted food intake 4. Genetic: - Kras - 5q (APC gene) - 17q (p53 gene) - 18q - DPC4 - SMAD4 - MSI-H (Microsatellite Instability-High)

Crohn Disease Pathology

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Q) Which of the following is not characteristic of Crohn Disease  : * (From AIIMS 2020 November GI)  

a) Granular mucosa
b) Transmural involvement
c) Skip lesions
d) Giant cell granuloma

Ans a ) Granular Mucosa- This is a feature of ulcerative colitis ( Table 49-7 Sabiston 20) 

The typical gross appearance of ulcerative colitis is hyperemic mucosa.

Friable and granular mucosa is common in more severe cases, and ulceration may not be readily evident. ( Saby 1340) 

IN Crohn disease - Microscopically, there are focal areas of chronic inflammation involving all layers of the intestinal wall with lymphoid
aggregates. Non-caseating giant cell granulomas are found in 60% of patients and when present clearly allow a confident diagnosis of CD.

( Bailey 1242) 

 

Carcinoid Syndrome

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Q) Carcinoid syndrome wrong statement is?
a) 40 % have Right  heart dysfunction in carcinoid syndrome

b) >1cm in appendix is  indication for Right  hemi colectomy
c) 30 %  jejunoileal carcinoid are metastatic
d) Resection of primary is done in presence of metastatic disease

 

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

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