1. SURGICAL CONDITIONS OF THE INTESTINES

2. ANATOMY AND PHYSIOLOGY OF THE SMALL INTESTINE
Small bowel consists of:
Duodenum, jejunum, ileum
Main role of duodenum: chemical digestion of chyme
Types of activity patterns: peristalsis and segmentations

3. ANATOMY AND PHYSIOLOGY OF THE SMALL INTESTINE
Main role of jejunum:
Absorb nutrients from chyme
In ileum:
chyme accumulates and awaits the opening of the ileocecal sphincter to enter the large bowel

4. DIVERTICULOSIS OF THE SMALL INTESTINE
Multiple saclike mucosal herniations through weak points in the intestinal wall.
Less common than colonic diverticula. 
Cause: Not known. Believed to develop as the result of abnormalities in peristalsis, intestinal dyskinesis (inability to control movement)
and high segmental intraluminal pressures.
Classified as true and false.
True diverticula -> composed of all layers of the intestinal wall
False diverticula -> herniation of the mucosal and submucosal layers

5. DIVERTICULOSIS OF THE SMALL INTESTINE
Small bowel diverticula are generally asymptomatic 
Patients who develop symptoms generally report symptoms that reflect associated complications. The most common symptom is nonspecific epigastric pain or a bloating sensation. 
Complications:
-Chronic abdominal pain
-Diverticulitis
-Intestinal obstruction
-Intestinal hemorrhage
-Malabsorption
The prognosis is good even with
complications.
asymptomatic diverticula, conservative approach & avoid constipation
painful diverticular disease involves adding fiber to the diet and not eating foods that cause gas, pain, or other symptoms. 

6. MECKEL’S DIVERTICULUM
-Most common congenital abnormality of the gastrointestinal tract.
-Embryologic problem of the vitellin duct
-Found in 1% to 2% of the population, with slightly higher male incidence
-Typical location; distal ileum
Complications are rare but if they happen:
-children; occult bleeding from diverticulum,
manifesting as unexplained anemia. Brisk hemorrhage,
melena or even hematochezia has been seen.
-adult; bowel obstruciton
Rarely diagnosed preoperatively [acute appendicitis]

7. MECKEL’S DIVERTICULUM
Surgical treatment:
In the acute setting, limited resection of the ileal segment containing the diverticulum
with primary anastomosis is indicated.

8. TUMORS OF THE SMALL INTESTINE
Malignant neoplasms of the small bowel are among the rarest types of cancer (2% of all GI cancers)
Most are never discovered. When discovered often metastasized to distant sites. Reason: difficult to see small bowel with endoscopy.
Most are benign and asymptomatic.
Symptoms: GI bleeding , small bowel obstruction, instussuseption (part of intestine slides into adjacent part of intestine).
If tumor is malignant other typical cancer symptoms can exist (fatigue, anemia, weight loss)

9. TUMORS OF THE SMALL INTESTINE
Benig neoplasms
Most small bowel neoplasms are benign and found coincidentally
Small bowel polyps should be removed and biopsed
Malignant neoplasms
Include:
->gastrointestinal stromal tumors
Mostly found in ileum
Bleeding
Treatment: resection
->Adenocarcinoma 40%
Mostly found in duodenum or proximal jejunum
Treatment : whipples procedure (pancreaticoduodenectomy) or palliative stenting
->Carcinoid tumor 30%
Serotonin secreting tumor
Carcinoid syndrome->flushing, wheezing, diarrhea
Mostly found in appendix. Also ileum.
For acute symtoms octreotide or cyproheptadine

10. TUMORS OF THE SMALL INTESTINE
->small bowel lymphoma 20%
increaed incidense in patients who are immunocompromised,
have crohns or celiac disease.
Treatment: resection.
If disease is disseminated->chemotherapy

11. SHORT BOWEL SYNDROME
A complication related to extensive small bowel resection/damage.
Inadequate small bowel to absorb nutrients, fats, vitamins, electrolytes.
Symptoms: Malnutrition, weigh loss, abdominal pain, symproms related to vitamin and mineral deficiencies (esp. B12 deficiency if you remove parts of terminal ileum)
Diagnosis; history of small bowel resection/damage
Treatment; adequate oral nutrition.
Increased caloric intake, vitamine and mineral
supplementation, anti-peristaltic agents to slow
things down.
Important parameters, always check in resection
of small bowel;
electrolyte , urine output, serum albumin, weight

12. ANATOMY AND PHYSIOLOGY OF THE LARGE INTESTINE
Large intestinal task: absorb water and vitamins while converting digested food into feces

13. NONSPECIFIC INFLAMMATIONS OF THE LARGE INTESTINE
Inflammatory Bowel Disease
• Ulcerative colitis - nonspecific inflammatory bowel disease of unknown etiology that effects the mucosa of the colon and rectum
• Crohn’s disease - nonspecific inflammatory bowel disease that may affect any segment of the gastrointestinal tract
• Indeterminate colitis
– 15% patients with IBD impossible to differentiate

14. NONSPECIFIC INFLAMMATIONS OF THE LARGE INTESTINE
Idiopathic inflammatory autoimmune disease process involving GI tract
Can happen to anybody but 20s and 30s more common.
Increased risk of colon cancer
Two types:
Chrons diseasse
Ulcerative colitis
Symptoms: chronic abdominal pain, bloody diarrhea (the inflammation of bowel makes it difficult to absorb water), mucus in stool, systemic symptoms (fever, weight loss, sweats, malaise, arthralgia, nausea, vomiting)
Extraintestinal symtoms:
skin, eyes, joints, liver
Colonoscopy with biopsy gold standard for diagnosis.

15. NONSPECIFIC INFLAMMATIONS OF THE LARGE INTESTINE

16. NONSPECIFIC INFLAMMATIONS OF THE LARGE INTESTINE
Chrons disease: Affect the entire thickness of the tissue and the entire GI tract can be affected.
Fistula, aphthous ulcers, chrons ileitis (ulcertion of terminal ileum)
ASCA (+)
Ulcerative colitis: limited to the large bowel, primarily affects rectum.
Tenesmus (earge to defecate but there is no stool) + mucus passage
ANCA (+)
Treatment: 1st line ASAs Mesalamine derivatives (longterm )
Steroid sparing agents: inhibit inflammation
Surgical treatment is curative for UC