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SMALL BOWEL

Learn about the different types of small bowel tumors, their symptoms, and treatment options. Discover the risk factors associated with these tumors and the importance of early detection for better outcomes.

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SMALL BOWEL

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  1. SMALL BOWEL

  2. TUMORS • CLASIFICATION • Origin : Benign Malignant • Epitelium adenoma adenocarcinoma • Enterocromaphine cells - carcinoid • Conjunctiv: fibroma fibrosarcoma • Vascular: hemangioma angiosarcoma • lymfangioma - • Lymphoid - limphoma • Smooth muscle leiomioma, GIST leiomiosarcoma GIST • Nervi and nerve sheat neurofibroma neurofibrosarcoma • neurinoma schwannoma malignant • Adipocite lipoma liposarcoma • Others sdr Peutz-Jeghers metastatic tumors • melanoma malign

  3. TUMORS • Risk factors • FAP, Crohn, CCNPE, Peutz-Jagers, ABD • Controversial • Smoking, alcohol (>80g/days), read meat, salty food • TB • GIST • Adenoama • True simple adenoma, vilos adenoma, Brunner gland adenoma • Malignant potential!!!! • Lipoma • Hamartoama • Sdr Peutz-Jagers • Malignant potential • TM • Adenocarcinoma– 50% • Carcinoid • GIST • limphoma

  4. SYMPTOMS • Depend on location and relation to the bowel lumen • Localization • Very high positioned tumors (jejunal) – symptoms very similar with distal duodenal stenosis • Ileal tumors – later symptoms (related to food ingestion) – may be similar with apendicitis crisis • According to type of development • endolumenal – intestinal obstruction through: • obstruction • Intermitent invagination • Intramural – may favor invagination but also volvulus

  5. TUMORI INTESTIN SUBŢIRE • Clinical diagnosticmay be suggested by: • Dispeptic symptoms • Non-characteristic; • Abdominal pain: non precise, diffuse, intermitent • Alternation of diarhea and constipation • Recurrent incomplete obstruction • Colicky abdominal pain in the mesogastrum; • Palpable distended bowe loop; • Borborism, najor emission of flatus and feaces (sdr. Kőnig). • GI bleeding • Ocult bleeding or melena + aneamia • Palpable tumor • Unusual: mobile or fix (adesions); • Same area as the borborism or colicky pain • Sometimes palpable through vagina or recta touch; • Vanishing tumor: may be produced by invagination

  6. Paraclinical examination • Lab: • Aneamia, microcytic, hyochromic; • Increased ESR; • Adler test pozitiv (occult bleeding); • ACE and ά fetoprotena: may be increased but non often and not important • acid 5-hidroindolacetic (5-HIAA) may be rised in carcinoid tumors (metastatic disease – high values)

  7. Radiology: • Plain X Ray: • Oclusion: hidroaeric levels on the small bowel; • Meteorism (incomplete obstruction); • Barium follow up: • Better for high positioned tumors • Barium enema for distal ileum; • Enteroclisis- better results for small bowel. • BENIGN TUMORS • Filing defect: • circular • Well circumscribed; • Mucosal margin clear • Stenosis: • Regular margins; • Clear mucosal margins; • Normal persitalsis of the bowel • Invagination: • jejuno-jejunal; • ileo-ileal; • ileo-colic.

  8. TUMORS • Malignant tumors • Filing defect • irregular • Cmucosal layer discontinuos • Stenosis: • Irregular borders; • Wall invasion. • Dilation • Indirect signs • Small bowel loops adjacent to a tumor with dilated loops above the tumor • Bowel loops pushed against a region of the abdomen – displacement

  9. EXPLORATION • Ultrasound • Structure: solid, cystic, • Position • Dimension • Can detect • invagination; • Stasis above a tumor; • Regional LN; • Ascitis. • Can show liver MTS; • Biopsy guided on US • CT

  10. EXPLORATION • Arteriography • Most beneficial in cases of bleeding – contrast pooling near lesion • Can show the tumor in highly vascular tumors : • Hemangioama; • Hemangiosarcoama. • Beneficial in low vascular tumors – adenocarcinoma (disruption of normal vasculature). • Endoscopy – enteroscopy: • Unusual - difficult • SDifferent techniques – all the bowel can be visualized • Laparoscopy, laparotomy

  11. COMPLICATIONS • Intestinal obstruction • Mechanism: • Obstruction; • Invagination; • Volvulus; • Alimentary bolus impaction or foreign body – partila stenosis produced by the tumor; • Perforation • Mechanism: • necrosisand ulceration of the tumor; • Diastatic – dilated loop above stenosis • Tumor infection • Haemorhagy • Spontaneous rupture of the pedicle: – tumor destruction + bleeding important

  12. TREATMENT A. Surgical • Benign tumors: • Small: enterotomy + enucleation + eneroraphy • Big: segmental enetrectomy. • Malignant tumors: • Segmental enterecomy with security margins + LN clearing: dubtful – radicality is often impossible due to unlimited LN teritory. And rapid spread in the LN in the paraaortic and retropancreatic regions ; • Distal ileum: right colectomy ; • Paleation: resections / by pass. • B. Radiotherapy • Lymphomas are sensitive • C. Chemotherapy • Not very good in adenocarcinoma • Lymphoma tend to do better, at least at the begining.

  13. CARCINOID TUMORS • Small bowell – 2nd after apendix • More often - ileum • Serotonine excretion • Often small single tumor, yellow on section, developed in submucosa • Histologically bening BUT may have malignant behavior including MTS • Symptoms: identical with small bowel tumors + CARCINOID SYNDROME: • Facila flush; • GI hypermotility; • Hepatomegaly; • Bronchospasm • Right heart valvular lesions (endocardum nodules). • 5-HIAA detection in the blood ;

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