The failure of an enterocutaneous fistula to heal on a regimen of total parenteral nutrition and antisecretory therapy may be due to which of the following?
Factors which prevent healing of an enterocutaneous fistula include foreign body, epithelialization of the fistula tract, downstream obstruction, radiation enteritis, associated infection (abscess or sepsis), malignancy, and a short ( <2 cm) fistula tract.
Which primary malignancy of the small intestine is most common?
Adenocarcinomas of the duodenum are the most common primary small bowel malignancy and account for 35 to 50% of the total. Lymphoma and gastrointestinal stromal tumors (GISTs) of the small bowel are the least common and each accounts for 10 to 15% of the total.
Adenocarcinoma of the duodenum is associated with what hereditary oncologic syndrome?
Duodenal carcinoma is a late manifestation of the familial adenomatous polyposis (FAP) syndrome. After resolution of the colonic disease by total colectomy, patients with FAP must be followed with periodic upper gastrointestinal ( GI) endoscopy to maintain surveillance for duodenal tumors. Duodenal cancer is the leading cause of death among patients with FAP.
Which of the following statements is true regarding GISTs?
GISTs are a form of sarcoma which occur most commonly (70%) in the stomach. They more frequently present with GI hemorrhage than other small bowel malignancies. They are usually refractory to conventional cytotoxic chemotherapy, but are not usually metastatic on initial diagnosis. A radical lymphadenectomy is not usually required; a segmental resection of the involved portion of the small intestine is usually sufficient surgical treatment.
Methods to prevent radiation enteritis of the small bowel during pelvic irradiation for gynecologic or rectal malignancy include which of the following?
In addition to limiting radiation exposure to less than 5000 cGy, avoiding radiation to the small intestine after pelvic surgery can involve steep Trendelenburg positioning during radiation therapy sessions, closure of the pelvic peritoneum at the level of the sacral promontory to prevent small bowel filling the pelvis, and creating of an absorbable mesh sling to prevent the small intestine from filling the pelvic cavity.
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