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Pathoma GI > 10.5 Small Bowel > Flashcards

10.5 Small Bowel Flashcards

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1
Q

Congenital failure of duodenum to reanalyze; associated with Down syndrome

A

Duodenal atresis

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2
Q

3 clinical features of duodenal atresia

A
  1. polyhydramnios
  2. distention of stomach and blind loop of duodenum (double bubble sign)
  3. bilious vomiting
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3
Q

Outpouching of all three layers of the bowel wall (true diverticulum)

A

Meckel diverticulum

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4
Q

what causes meckel diverticulum?

A

failure of the vitelline (omphalomesenteric) duct to involute

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5
Q

4 rules of 2s for Meckel

A

2% of pop,
2 inches long,
within 2 ft of ileocecal valve,
can present w/i first 2 years

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6
Q

4 potential presentations of Meckel

A
  1. bleeding
  2. volvulus
  3. intussusception
  4. obstruction
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7
Q

what causes bleeding in meckel?

A

heterotopic gastric mucosa

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8
Q

twisting of bowel along its mesentery; results in obstruction and disruption of blood supply with infarction

A

volvulus

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9
Q

most common location of volvulus in elderly

A

sigmoid colon

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10
Q

most common location of volvulus in young adults

A

cecum

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11
Q

telescoping of proximal segment of bowel forward into distal segment

A

intussusception

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12
Q

in kids, most common cause of intussusception

A

lymphoid hyperplasia (e.g. due to rotavirus)

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13
Q

in kids, most common location of intussusception

A

terminal ileum (–>I in cecum)

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14
Q

in adults, most common cause of intussusception

A

tumor

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15
Q

abdominal pain + bloody diarrhea + decreased bowel sounds

A

small bowel infarction

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16
Q

three causes of small bowel infarction

A
  1. Thrombosis of SMA
  2. Embolism of SMA
  3. Thrombosis of mesenteric vein
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17
Q

decreased function of the lactase enzyme found in the brush border of enterocytes

A

lactose intolerance

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18
Q

normal function of lactase

A

lactose –> glucose + galactase

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19
Q

presents with abdominal dissension and diarrhea upon consumption of milk products; undigested lactose is osmotically active

A

lactose intolerance

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20
Q

Lactose intolerance on LM?

A

totally normal intestinal mucosa

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21
Q

immune-mediated damage of small bowel villi due to gluten exposure; associated with HLA-DQ2 and DQ8

A

Celiac disease

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22
Q

most pathogenic component of gluten

A

gliadin

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23
Q

once absorbed gliadin is deamidated by

A

tissue transglutaminase (tTG)

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24
Q

deamidated gliadin is presented by APCs via

25
damage in celiac mediated by
helper T cells (CD4+)
26
presentation of celiac in a child
abdominal distension, diarrhea, failure to thrive
27
presentation of celiac in an adult
chronic diarrhea and bloating, maybe dermatitis herpetiformis
28
what causes dermatitis herpetiformis
IgA deposition at the tips of dermal papillae
29
Lab findings in celiac
IgA antibodies against endomysium, tTG, or gliadin; also IgG
30
How would you diagnose celiac in someone with IgA deficiency (inc. incidence of this in celiac)?
IgG
31
duodenal biospy in celiac
flattening of villi + hypertrophy of crypts + inc. intraepithelial lymphocytes
32
where is damage most prominent in celiac?
duodenum (jejunum and ileum are less involved)
33
late complications of celiac that present as refractory dz despite good dietary control
small bowel carcinoma, T-cell lymphoma
34
damage to small bowel villi due to an unknown organism resulting in malabsoption
tropic sprue
35
unlike celiac, tropical sprue has the following characteristics
- tropical regions - arises after infectious diarrhea - gets better w. antibiotics - damage most prominent in jejunum or ileum
36
where is damage most prominent in tropical sprue
jejunum and ileum (duodenum less commonly involved)
37
tropical sprue may lead to what deficiencies
vitamin B12 or foalate
38
systemic tissue damage characterized by macrophages loaded with Tropheryma whippelii organisms; PAS+
Whipple dx
39
where are the partially destroyed organisms in Whipple dz?
Macrophage lysosomes (PAS+)
40
common site of involvement in whipple?
small bowel lamina propria
41
macrophages compress what in whipple?
lacteals
42
macrophage compresses lacteals, so chylomicrons cannot be transferred from enterocytes to
lymphatics
43
whipple presents as
fat malabsorption and steatorrhea
44
4 whipple sites o/s small bowel
1. synovium of joints (arthritis) 2. cardiac valves 3. lymph nodes 4. CNS
45
AR deficiency of ApoB48 and ApoB100
abetalipoproteinemia
46
AR deficiency of ApoB48 and ApoB100 due to mutation in
MTP gene
47
abetalipo presents with malabsorption due to
defective chylomicron formation (requires B46)
48
abetalipo p/w absent plasma VLDL and LDL b/c
requires B100
49
malignant proliferation of neuroendocrine cells anywhere along gut; low-grade malignancy; chromogranin +;
carcinoid tumor
50
most common site of carcinoid
submucosal polyp-like nodule in small bowel
51
carcinoid may secrete serotonin --> portal circ. --> metabolized by
liver MAO into 5HIAA
52
liver MAO metabolizes serotonin to
5HIAA
53
what metabolite in the urine indicates carcinoid?
5HIAA
54
how could serotonin bypass liver metabolism in carcinoid?
met to liver
55
carcinoid met to liver releases serotonin into hepatic vein -->
hepato-systemic shunts --> systemic circulation
56
three symptoms of carcinoid
bronchospasm + diarrhea + flushing
57
carcinoid symptoms can be triggered by
alcohol or emotional stress
58
carcinoid heart disease is characterized by increased collagen where?
RIGHT HEART (TIPS)
59
why is carcinoid HD not seen in left heart
MAO in lung

Pathoma GI (8 decks)

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