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Meckel's Diverticulum.pptx
This document provides tips for using a PowerPoint presentation (ppt) on Meckel's diverticulum. Some key points: - Slides can be edited and modified as needed. - Many slides are blank except for the title to facilitate active learning sessions where students provide information before each slide is shown. - The presentation will be run through three times with questions asked and answers shown to reinforce learning. - It provides an overview of the anatomy, embryology, clinical presentation, investigations and treatment of Meckel's diverticulum. - Learning objectives are to describe the anatomy and applied anatomy of Meckel's diverticulum.
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Meckel's Diverticulum.pptx
- 1. Tips on usingmy ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about aetiology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. 7. See notes for bibliography.
- 2. Learning Objectives • Atthe end of this session the learner will be able to describe the – – Anatomy and applied anatomy of Meckel's Diverticulum.
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- 4. Introduction & History Meckel'sDiverticulum: • The most common congenital anomaly of the gastrointestinal tract. • Remains of vitelline duct of embryo. • Usually found incidentally during abdominal operations. •
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- 7. Rule of twos •Present in 2% of people • 2 feet from ileocecal junction • 2 inch long • Contains ectopic mucosa about half the time • Contains gastric or pancreatic tissue. • Often presents before age 2 years (or within the first 2 decades of life), • Is twice as likely to be symptomatic in boys than girls.
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- 9. Embryology • A Meckel’sdiverticulum results from incomplete obliteration of the Vitelline duct aka. Omphalomesenteric duct which connects the midgut to the yolk sac in the fetus. • Early in embryonic life, the fetal midgut receives its nutrition from the yolk sac via the Omphalomesenteric/Vitelline duct. • The Omphalomesenteric duct normally involutes between the fifth and sixth weeks of human gestation as the bowel settles into its permanent position within the abdominal cavity.
- 10. Embryology • The persistenceof the omphalomesenteric duct beyond fetal development may result in a variety of anatomic patterns- – The most common form is a diverticulum without additional attachment, commonly referred to as Meckel's diverticulum – Omphalomesenteric cysts – Omphalomesenteric fistulas that drain through the umbilicus – Fibrous bands from the diverticulum to the umbilicus that predispose to bowel obstruction. – Umbilical sinus.
- 11. Anatomy • Meckel's diverticulumis a true diverticulum, containing all layers of the small bowel wall .
- 12. Microscopic Anatomy • Themucosal lining of the diverticulum may contain heterotopic mucosa (most commonly gastric). •
- 13. Heterotopic mucosa • Heterotopicgastric mucosa was found in 62% of cases, • Pancreatic tissue was found in 6%, • Both pancreatic tissue and gastric mucosa were found in 5%, • Jejunal mucosa was found in 2%, • Brunner tissue was found in 2% • Both gastric and duodenal mucosa were found in 2%. • Rarely, colonic, rectal, endometrial, and hepatobiliary tissues have been noted.
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- 15. Applied Anatomy • Usuallyfound incidentally during abdominal operations. • Less commonly, they are found incidentally on diagnostic imaging. • Inflammation may mimic Acute appendicitis. • Clue is shifting tenderness. •
- 16. Applied Anatomy: Symptoms •Usually asymptomatic. • Can cause - – Peptic Ulceration and present with lower gastrointestinal (GI) bleeding – Diverticulitis- Abd. pain – Small bowel obstruction (SBO). – Intussusception – Perforation. – As many as 5% of complicated Meckel diverticulum contain malignant tissue. – Neuroendocrine tumors arising from Meckel diverticulum are very rare.
- 17. Applied Anatomy: Symptoms •In children bleeding PR is more common. • In adults diverticulitis and intestinal obstruction are more common. • Complications become less common with increasing age.
- 18. Applied Anatomy: Investigations –Computed tomography (CT) has become an invaluable tool for the evaluation of abdominal pain. CT scanning is useful in demonstrating acutely inflamed diverticula, typically identified as a blind pouch off the distal small intestine and associated with bowel wall thickening – A Meckel’s scan (technetium-99m scan) can detect the diverticulum in hemodynamically stable patients. – Bleed scan -Technetium-99m lebelled RBC scan. – For those with active bleeding, arteriography is the diagnostic option. – Capsule endoscopy – Magnetic resonance imaging (MRI) – Single-photon emission tomography /CT (SPECT/CT) scanning.
- 19. Applied Anatomy: Treatment •The treatment for a symptomatic Meckel’s diverticulum is surgery.
- 20. Applied Anatomy: Treatment •Resection of incidental Meckel's found during laparotomy is controversial in children and adults. • It is generally recommended that asymptomatic Meckel's to be resected in children during laparotomy • Incidentally found normal-appearing Meckel's diverticulum should not be resected in adults. • Elective prophylactic resection of asymptomatic Meckel's diverticulum identified on imaging is not recommended for both children and adult.
- 21. Applied Anatomy: Treatment Indicationsfor incidental resection – • If there is a palpable abnormality (suggestive of the presence of ectopic mucosa) • A long diverticulum (>4 cm) • A narrow neck or base of diverticulum (<2 cm wide)
- 22. Applied Anatomy: Treatment •The standard surgical approach is to perform a segmental (wedge or v-shaped diverticulectomy) resection of the narrow-based diverticulum or to perform a limited small bowel resection followed by primary end-to-end anastomosis if an inflamed or ulcerated diverticulum is encountered. • For bleeding -segmental small bowel resection followed by end-to-end ileoileostomy rather than simple diverticulectomy is preferred.
- 23. Minimally invasive Therapy •The long-term outcomes with laparoscopy approaches (including laparoscopic diverticulectomy and laparoscopic-assisted trans umbilical Meckel's diverticulectomy) are still lacking.
- 24. MCQ True about Meckel'sdiverticulum is- • A. Congenital anomaly of the intestine • B. Always heterotopic mucosa • C. Pseudodiverticulum • D. Located on mesenteric border
- 25. MCQ True about Meckel'sdiverticulum is- • A. Congenital anomaly of the intestine • B. Always heterotopic mucosa • C. Pseudodiverticulum • D. Located on mesenteric border
- 26. MCQ Least common complicationof Meckel's diverticulum (NEET 2018) a) Bleeding b) Obstruction c) Neoplasm d) Obstruction
- 27. MCQ Least common complicationof Meckel's diverticulum (NEET 2018) a) Bleeding b) Obstruction c) Neoplasm d) Obstruction
- 28. MCQ • Meckel's diverticulummost commonly presents as: A. Gastrointestinal bleeding. B. Obstruction. C. Diverticulitis. D. Intermittent abdominal pain
- 29. MCQ • Meckel's diverticulummost commonly presents as: A. Gastrointestinal bleeding. B. Obstruction. A. Diverticulitis. B. Intermittent abdominal pain
- 30. MCQ • How proximalto the caecum is a Meckel's diverticulum usually found? • A 20 cm • B 30 cm • C 40 cm • D 50 cm • E 60 cm
- 31. MCQ • How proximalto the caecum is a Meckel's diverticulum usually found? • A 20 cm • B 30 cm • C 40 cm • D 50 cm • E 60 cm
- 32. MCQ • What percentageof the general population have a Meckel's diverticulum? • A 2% • B 5% • C 10% • D 15% • E 20%
- 33. MCQ • What percentageof the general population have a Meckel's diverticulum? • A 2% • B 5% • C 10% • D 15% • E 20%
- 34. MCQ • What isthe most common cause of intussusception in adults? A. Colorectal carcinoma B. Gastrointestinal stromal tumor C. Lymphoid hyperplasia D. Meckel diverticulum E. Small bowel lymphoma
- 35. MCQ • What isthe most common cause of intussusception in adults? A. Colorectal carcinoma B. Gastrointestinal stromal tumor C. Lymphoid hyperplasia D. Meckel diverticulum E. Small bowel lymphoma
- 36. Teaching Point In adults,a lead point is frequently identified up to 90% of the time, usually malignant in the large bowel and benign in the small bowel. Lead points are numerous and include: • Gastrointestinal malignancy (most common cause in adults, accounting for 65% of cases) • Colorectal carcinoma (most common) • Metastases, e.g. Malignant melanoma, breast cancer, lung cancer • Small bowel lymphoma/Burkitt lymphoma • Benign neoplasms • Gastrointestinal stromal tumor (GIST) • Intestinal polyps • Intestinal lipoma • Polypoid hemangioma • Congenital • Meckel diverticulum • Duplication cyst • Ectopic pancreas • Inflammatory • Peri appendicitis • Trauma • Mural hematoma
- 37. Get this pptin mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
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Editor's Notes
- #2 drpradeeppande@gmail.com 7697305442
- #14 What are Brunner cells? Brunner glands are composed of ramifying tubules lined principally by cells resembling the mucus-secreting cells of the gastric antral mucosa. Brunner glands also contain endocrine cells that store various polypeptides. Brunner glands lie predominantly in the duodenal submucosa, just beneath the muscularis mucosae.
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