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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 Q. Which of the following hormones are not released in duodenum?
a) Gastrin
b) Motilin
c) Somatostatin

d) Pancreatic YY

4. d
Peptide YY is released from ileum.

Gastrin - G cells stomach
Motilin- M cells from duodenum and jejunum
Somatostatin - D cells in pancreas, stomach and duodenum

Somatostain is an inhibitory hormone and inhibits most of the things

Secretin is released by acid in the duodenum and stimulates pancreatic fluid and bicarbonate secretion, leading to neutralization of acidic chyme in the intestine. Secretin also inhibits gastric acid secretion  and intestinal motility. LES pressure is decreased by Secretin, CCK, Somatostatin and VIP

 

Duodenal adenoma in FAP

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Q) 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