What ectopic tissue is commonly found in a Meckel diverticulum?
Approximately 60% of Meckel diverticula contain ectopic tissue, of which over 60% consists of gastric mucosa. Pancreatic acini are next most common, followed by pancreatic islets, endometriosis, and hepatobiliary tissues. Gastric mucosa can ulcerate and bleed, the etiology of which can be hard to determine unless the Meckel diverticulum is known.
A patient with recent onset of ascites after an episode of acute pancreatitis undergoes paracentesis, which reveals cloudy white fluid. What therapy is indicated?
Chylous ascites can develop as a complication of operative procedures or inflammatory conditions such as acute pancreatitis. Lymphatic drainage from damaged lymphatics can heal when the patient is made NPO, and maintained on TPN and octreotide. Medium-chain triglycerides have been advocated as an oral diet, but temporary cessation of oral feeding and octreotide comprise the most successful therapy.
Short bowel syndrome has been arbitrarily defined in adults as having a small intestine ofless than what length?
A functional definition, in which insufficient absorptive capacity results in diarrhea, dehydration, and malnutrition is more appropriate, but a standard definition of short bowel syndrome of 200 cm has been used widely.
Common causes of short bowel syndrome include all of the following EXCEPT:
In adults, the common etiologies of short bowel syndrome include mesenteric ischemia, malignancy, and Crohn's disease. In pediatric patients, common causes include intestinal atresias, volvulus, and necrotizing enterocolitis. Radiation enteritis usually involves isolated segments of small bowel of less than 50% of total small intestinal length.
After an emergency operation for bowel infarction in which more than half of the small intestine was removed and a jejunostomy created, high volume ostomy losses cause recurrent dehydration. Management of this condition includes which of the following?
Reducing gastric secretion with proton pump inhibitors or histamine-2 receptor antagonist, reducing gastroenteropancreatic secretions with octreotide, and inhibiting motility with agents such as loperamide or diphenoxylate, are useful approaches to prevent dehydration as the short gut adapts to its new length. Total parenteral nutrition is also often required.
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