Dr Alaa Jamel Tumours of the small intestine Classification Benign Adenoma Gastrointestinal stomal tumour lio myoma Lipoma Hamartoma eg peutzjeghers syndrome associated with ID: 1045470
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1. Tumours of the small intestine Dr. Alaa Jamel
2. Tumours of the small intestineClassificationBenign AdenomaGastrointestinal stomal tumour (lio myoma)LipomaHamartoma (e.g. peutz-jeghers syndrome associated with circumoral pigmentation and multiple intestinal polyps).
3. Malignant1. PrimaryAdenocarcinomaLymphomaCarcinoidGastrointestinal stomal tumour2. Secondary invasion ( e.g. from stomach, colon or bladder, or from a lymphoma)Clinical featuresTumours of the small intestine present with the following:Intestinal bleedingObstruction Intussusceptionsvolvulus
4. PEUTZ-JEGHERS SYNDROM (autosomal dominant Inherited syndrom)This consist of1-familial intestinal hamartomatous polypoisis affecting the jejunum where its a cause of hemorrhage and often intussusceptions 2-melanosis of oral mucous membrane and the lipsSome time appear in the digitsHISTOLOGYThe polyps can be likened to trees. The trunk and branches are smooth muscle fibres with normal mucosa.TREATMENTAs malignant changes rarely occur so surgical excision need when there is bleeding or intussusceptions .Large single polyps can be remove by enterotomyOr resects of part of bowel which heavily involve but polyps within reach can be snared by colonoscopy.
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9. CARCINOID TUMOUR:-These tumours occur throughout the G.I.T.most commonly in the appendix,ileum,and rectum.They arise from neuroendocrine cells at the base of intestinal crypts.the primary lesion usually small but when metastasis usually involve liver.10% associated with MES1 .MACROSCOPICLYIts yellow sub mucosal nodule.mucosa at beginning lock normal but later ulcerated and if it extend to serosa causing fibrosis and abstraction.25%of cases are multiple4% are metastasis
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11. C.FDue to the effect of serotonin1.flushing95%with attach of cyanosis and chronic red face precipitated by alcohol and stress.2.diarrhea70%3.abdominal pain 40%4.broncospasm 15%5.abnormality of heart .pul.and tricuspid valve lesionINVESTIGATION1.5H.I ACETIC ACID in the urine metabolism of 5 HT2. c.t.scan and u.s for liver metastasis3.radiolabelled octreotide scintography for detection of metastasis
12. TREATMENT:-most patient with G.I carcinoids don’t have carcenoid syndrom.so surgical resaction is usually sufficient.RESACTION IN EARLY CASESMultiple enoculation of hepatic metastases or even partial hepatectomy can be carried out.But with extensive liver metastasis treat.by emboli zing the hepatic arterySymptoms may control with octrotide.
13. LYMPHOMAThere are 3 main typesA-western type lymphoma. Its annular ulcerating lesion, some time multiple.B-primary lymphoma associated with coeliac diseaseC-mediterranean lymphoma. Mostly found in north Africa and middle east.TREATMENT by chemotherapy
14. Meckel's diverticulum :-Meckel's diverticulum is the remnant of the Vitello-intestinal duct of the embryo . it lies on the antimesenteric border of the ileum and, as an approximation , occurs in 2% of the population, 2 feet (60 cm) from the caecum, and averages 2 inches ( 5 cm) in lengthClinical features :-It may present in numerous ways:A symptomless finding at operation or autopsyAcute inflammation, clinically identical to acute appendicitis Perforation by foreign body presenting as peritonitis Intussusceptions (ileo-ileal)Peptic ulceration with sever haemorrhge due to contained heterotopic gastric epithelium, which bears HCL-secreting parietal cells. This particularly occurs in children and characteristically is the cause of Melina at about the age of 10 years . rarely, the peptic ulcer perforates or gives rise to post-cibal pain . The diverticulum may also contain ectopic pancreatic tissue.Patent vitello-intestinal duct, presenting as an umbilical fistula that discharges intestinal contentsVitello-intestinal band stretching from the tip of the diverticulum to the umbilicus, which may snare a loop of intestine to produce obstruction or act the apex of a small bowel volvulus
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17. Special investigations :-Most diverticula are incidental findings. However the following investigations may be indicated Technetium scan . radiolabelled technetium (99mTc) is taken up by gastric mucosa, and scintigraphy will outline to stomach usually near the right iliac fossa (RIF)Barium follow-through may show the diverticulum arising from the antimesenteric border.Treatment involves resection of the diverticulum because of broad based should not be amputated as appendix because may cause stricture.