Small-Intestinal Neoplasms its causes,clinical picture,diagnosis,newest treatment

Neoplasms of the small intestine, either benign or malignant are unusual but not rare, comprising less than 5% of all gastrointestinal tumors.  Because they are uncommon and relatively inaccessible to standard diagnostic studies, the diagnosis of small-bowel tumors is sometimes delayed.

Diagnosis

. Clinical presentation.  Small-Intestinal (SI) tumors usually occur in people over age 50.  the presenting signs and symptoms are similar whether the tumors are benign or malignant.  Small-bowel obstruction, either partial or complete, manifested by abdominal pain or vomiting or both, is a frequent presentation.  Chronic partial obstruction may predispose to stasis  and bacterial overgrowth, leading to bile acid deconjugation and malabsorption. Bleeding from the tumor or 

     Perforation of the bowel is rare.  If a duodenal tumor is located in the vicinity of the ampulla of Vater, obstruction of the common bile duct may develop, resulting in biliary stasis and jaundice.  Weight loss commonly accompanies malignant tumors.

                       The physical examination usually is nondiagnostic.  Signs of small-bowel obstruction may be evident, such as a distended, tympanic abdomen and high-pitched bowel sounds.  Occasionally malignant small-bowel tumors can be palpated.  Stool may be positive for occult blood.

Laboratory and other diagnostic studies

1. Blood studies.  Anemia may develop because of blood loss or malabsorption. Hypoalbuminemia can occur in metastatic liver disease.

2. An upright pain x-ray film of the abdomen may show air-fluid levels in patients with small-bowel obstruction.

3. Barium-contrast x-ray studies. out  frank obstruction but perhaps with colicky pain or bleeding typically undergoes barium-contrast x-ray studies.  The typical "napkin ring" deformity of adenocarcinoma encircling the bowel.

4. Endoscopy and biopsy.

5. Capsule endoscopy.

6. Ultrasound and computed tomography scan.

7. Selective arteriography

Treatment

1. Surgery.
2. Radiation therapy and chemotherapy of other malignant small-bowel tumors have been largely ineffective.

Nutritional therapy