Difference between revisions of "Small intestine"

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Small intestine (view source)

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→‎Small bowel obstruction: split out
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==Small bowel obstruction==
==Small bowel obstruction==
*Abbreviated ''SBO''.
*Abbreviated ''SBO''.
:This section gives an overview of SBOs. Its primary focus is benign causes of SBO that have nonspecific pathologic findings. Specific causes definitively identified by pathology, e.g. [[adenocarcinoma]], are dealt with separately.
{{Main|Small bowel obstruction}}
===General===
*Radiologic/[[clinical diagnosis]].
 
The usual causes of bowel obstruction (large & small) are (mnemonic) ''SHAVING'':
*Strictures (think [[IBD]]).
*Hernias.
*Adhesions.
*[[Volvulus]].
*Intussusception.
*Neoplasia.
*Gallstone ileus.
 
The top three are:<ref>URL: [http://www.emedicine.com/EMERG/topic66.htm http://www.emedicine.com/EMERG/topic66.htm]. Accessed on: 19 April 2011.</ref><ref>{{Ref TN2007 |GS21}}</ref>
* Adhesions > hernias > neoplasms.
 
In the context of bowel obstructions and IBD, pathologists often see resected [[stoma]]s (that were put in place emergently).  These specimens are usually fairly straight forward.
 
===Radiology===
*Air-fluid levels.
 
===Gross===
*+/-Adhesions.
*+/-Bowel contorted.
*+/-Luminal narrowing +/-proximal dilation.
*+/-Serosal exudate.
**Suggestive of perforation.
 
===Microscopic===
Features:
*+/-Adhesions (serosal).
**Dense fibrous tissue replaces the adipose tissue.
**+/-Increased vascularity.
*+/-Submucosal fibrosis.
*+/-[[Serositis]] - seen in small bowel perforation.
*+/-Foreign body-type granuloma - due to previous surgical intervention.
 
DDx:
*Small bowel [[adenocarcinoma]] - most important differential diagnosis.
*Metastatic adenocarcinoma - classically on the serosal aspect.
*[[Signet ring cell carcinoma]].
 
===Sign out===
<pre>
SMALL BOWEL, RESECTION:
- SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE) ASSOCIATED WITH FOCAL LUMINAL
  NARROWING.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
SMALL BOWEL, RESECTION:
- SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE), FOCAL LUMINAL NARROWING AND A
  FOREIGN BODY-TYPE GRANULOMA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====Ischemic changes====
<pre>
SMALL BOWEL, RESECTION:
- SMALL BOWEL WITH ISCHEMIC CHANGES, FIBROUS ADHESIONS, FOCAL SEROSITIS AND MURAL
  MICROABSCESS FORMATION.
- NO SIGNIFICANT VASCULAR PATHOLOGY APPARENT.
- NEGATIVE FOR MALIGNANCY.
</pre>


==Small bowel neoplasms==
==Small bowel neoplasms==
Michael
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