Small Bowel and Appendix.ppt

Small Bowel and Appendix Joshua Eberhardt, M.D. September 4, 2008 Diseases of the Small Intestine Inflammatory diseases Neoplasms Diverticular diseases Miscellaneous Inflammatory Diseases Crohn’s disease Tuberculous enteritis Typhoid enteritis Crohn’s Disease Chronic granulomatous disease of the GI tract Spontaneous remissions and acute exacerbations Peak 2nd and 4th decades Most common surgical disease of the SB Operation is rarely curative and for treating complications Crohn’s Disease No known etiology ?Autoimmunity Earliest lesion: aphthous ulcer Ulcer ? transmural inflammation ? coalescence of ulcers (clefts/ sinuses) ? “cobblestone” Thickening and hypertrophy of bowel wall and narrowing of lumen Non-caseating granulomas in bowel wall and in LN Crohn’s Thickened and shortened mesentery “Skip areas” “Creeping fat” Internal fistulae Clinical presentation Recurring and persistent abdominal pain, diarrhea (85%), weight loss, fever (30%) SB alone 30% perianal dz 25% Ileocolitis 55% 41% Colon alone 15% 48% Perianal disease alone 5% Diagnosis and Treatment UGI/ SBFT CT scan Medical management Surgical management Obstruction – stricturoplasty, resection Abscess Fistulae – enteroenteral, enterocutaneous Perforation Malignancy Neoplasms Benign Adenoma Leiomyoma Lipoma Hamartomas, fibroma, angioma, lymphangioma, neurofibroma, hemangioma Malignant Adenocarcinoma Sarcoma Lymphoma Carcinoid Benign neoplasms May be asymptomatic Vague symptoms Obstruction Bleeding – anemia, Guaiac +ve stool, melena/ hematochezia Dx: SBFT, CT scan Tx: resection Benign neoplasms Adenomas 20% in duodenum, 30% in jejunum, 50% in ileum True adenomas Villous adenomas Leiomyomas (GIST) Most common symptomatic lesion of SB Most common in jejunum Lipomas Most common in ileum Peutz-Jeghers Syndrome Autosomal dominant Mucocutaneous melanotic pigmentation and multiple GI polyps (hamartomas) No malignant potential Jejunum and ileum most commonly involved 50% with colorectal polyps, 25%