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Small Bowel, SBO, IBD Outline Small bowel physiology Absorption Barrier SBO physiology ...

Date post: 17-Jan-2016
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Small Bowel, SBO, IBD Outline Small bowel physiology Absorption Barrier SBO physiology Hyperperistalsis Decreased absorption Increased secretion Clinical aspects
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Page 1: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Small Bowel, SBO, IBD

Outline Small bowel physiology

Absorption Barrier

SBO physiology Hyperperistalsis Decreased absorption Increased secretion Clinical aspects

Page 2: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Small Bowel, SBO, IBD

Outline (cont’d) Crohn’s disease

Epidemiology Pathology Indications for operation

Ulcerative colitis Epidemiology Pathology Indications for operation

Page 3: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Small Bowel, SBO, IBD

Small Bowel Physiology Absorbs water, electrolytes, nutrients

Varies between jejunum and ileum Compromised in certain disease states

Requires glutamine as energy source Barrier function

Requires enteral nutrition for maintenance Compromised by lack of feeding ?Leads to nosocomial infection

Page 4: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
Page 5: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
Page 6: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
Page 7: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
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Small Bowel, SBO, IBD

SBO Physiology Global hyperperistalsis Decreased absorption of H2O & lytes Increased secretion of protein rich fluid Hypoperistalsis in late stages

Page 9: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Small Bowel, SBO, IBD

SBO Physiology Pain and tenderness doesn’t differentiate type Simple SBO

Usually partial Differentiation by plain X-ray or CT May resolve

Strangulated SBO Usually complete Often “closed loop” Requires urgent operation

Page 10: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
Page 11: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
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Page 13: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Crohn’s Disease

Epidemiology Disease of young adults

Peak incidence in late teens and 20’s Smaller peak in 50’s & 60’s

Incidence varies amongst ethnic groups Cause unknown

?Autoimmune ?Infectious ?Genetic

Page 14: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Crohn’s Disease

Pathology Full-thickness involvement Thickened bowel wall and mesentery 50% with non-caseating granulomas May involve any portion of GI tract

Page 15: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
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Page 17: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Crohn’s Disease

Pathology (cont’d) Ileal involvement most common Colon-only involvement seen Peri-rectal disease common Extra-intestinal manifestations Surgery not curative Malignancy uncommon

Page 18: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
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Page 21: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Crohn’s Disease

Indications for Operation Abscess Certain fistulae Obstruction Intractability

Page 22: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
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Crohn’s Disease

Surgical Considerations Important aspect of overall care Bowel conservation important

Limited resection Resect, don’t bypass

Long-term risk of short-gut is low J-pouch not an option in colonic disease

Page 24: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Ulcerative Colitis

Epidemiology Similar to Crohn’s disease Early and late incidence peaks Variable incidence among ethnic groups

Page 25: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Ulcerative Colitis

Pathology Involves only mucosa and submucosa Involves only colon and rectum Serosa normal Normal bowel wall thickness Normal mesentery

Page 26: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
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Page 28: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
Page 29: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
Page 30: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
Page 31: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Ulcerative Colitis

Pathology (cont’d) Extraintestinal manifestations Malignancy

Duration of disease Extent of disease

Page 32: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Ulcerative Colitis

Presentation Diarrhea, often bloody Abdominal pain Constitutional symptoms Weight loss Fulminant colitis Toxic megacolon

Page 33: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.

Ulcerative Colitis

Indications for Operation Bleeding (uncommon) Unresponsive fulminant colitis Toxic megacolon Intractability Inability to wean steroids Cancer prevention

Page 34: Small Bowel, SBO, IBD Outline  Small bowel physiology  Absorption  Barrier  SBO physiology  Hyperperistalsis  Decreased absorption  Increased secretion.
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Ulcerative Colitis

Surgical Aspects Colectomy curative Total proctocolectomy with ileostomy Ileo-anal pouch pull-through

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