2 Dis of Sm Bowel and appendix [5] devaraj? Flashcards Preview

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Flashcards in 2 Dis of Sm Bowel and appendix [5] devaraj? Deck (21):
1

Tumors of the appendix

Carcinoid (0.5%) - most common
- neuroendo tumor with rare chance of metastasis
- carcinoid syndrome with metastasis = serotonin syndrome

Epithelial - rare
- show same range as colon polyps and cancers
(dysplasia to adenocarcinoma )

2

Serotonin syndrome

episodic flushing
diarrhea
wheezing
right sided heart valve disease

- can present from carcinoid syndrome with mets

3

4 types of diarrhea

1. watery
2. steatorrhea
3. inflammatory/exudative
4. fxnal (IBS)

4

watery diarrhea

osmotic/secretory

osmotic: carbohydrate malabsorption or osmotic laxatives
- poorly absorbed luminal osmols

Secretory: bacterial toxins, neuroendocrine tumors, ileal bile salt malabsortion, STIMULANT laxatives, disordered motility regulation
- V. cholerae, Enterotoxogenic E.coli , Giardia lambia

5

How to differentiate btwn osmotic and secretory diarrhea

Normal stool osmolality = 290
Osm gap = 290-2(stool sodium+potassium)

if difference is >50 = osmotic
- makes sense, more ions present in stool

if

6

Steatorrhea/fatty diarrhea

malabsorption syndromes
- celiac, whipple's

Short bowel syndrome
- after surgery
- Bacterial overgrowth

Maldigestion/malabsorption
- pancreatic insufficiency
- inadequate luminal bile salt [ ]

7

Inflammatory/Exudative diarrhea

often bloody

Infecton
IBD
Ischemia

Infxn:
shigella, campylobacter, ETEC, salmonella, Yersinia, C. Diff

8

functional (IBS) diarrhea

abdominal pain and altered bowel habits in absence of organic cause
- pain improves with defecation
- back and forth btwn constipation + diarrhea

concerning sx: weight loss, rectal bleed, anemia, nocturnal symp, electrolyte abnormalities, elevated inflamm marks.

9

Clinical signs of malabsorption

weight loss
diarrhea
steaorrhea
vitamin deficiency

pale, bulky, malordorous stool - difficult to flush

10

Causes of malabsorption

surgery
bacterial overgrowth
meds
- phenytoin
pancreatic insufficiency
liver disease
intestinal inflammation/villus flattening
- celiac, whipples disease, tripical sprue
Ulceration
ischemia infiltration
- amyloidosis

11

malabsorption of this vit leads to...?
Vit A →
Vit D →
Vit E →
Vit K →

Vit A → night blindness (xeropthalmia)
Vit D → osteomalacia (common)
Vit E → hemolytic anemia
Vit K → clotting dysfxn (common)

12

Pancreatic insufficiency + its affect on maldigestion

90% of pancreas burned out → lipid maldigestion FIRST
(protein and carb malab are rare)
- chronic pancreatitis or CF

13

How does gastric bypass cause maldigestion?

not actually causing malabsorption, rather it is a mixing prob
causes inadequate mixing of food with biliary and pancreatic secretions.
- vit deficiencies (so give multivit!)

14

Celiac Spruce (gluten-sensitive enteropathy)
- what is it?
- histo?
- gross?

inflammatory disease of SMALL INT with consumption of wheat, barley, or rye

Loss of villi/villous flattening
Crypt hyperplasia
inter-epithelial lymphocyte

Scalloping mucosa

(80% are asymptomatic)

15

Celiac spruce is associated with MHC _____. and All have antibodies to _______, which leads to a _____ T cell response

Class II
Ab to tissue transglutaminase
CD4+

16

Presentation of Celiac Sprue (gluten-sensitive enteropathy)

abdominal distention
abdominal pain
anorexia
bulky, sticky, pale stools
- STEATORRHEA
Flatulence
Failure to thrive
Vomiting

17

Atypical Celiace Sprue sx

Iron def anemia
Dermatitis Herpetiformis
Elevated LFTs (AST+ALT)
Osteoporosis

18

Celiac pathogenesis
- assoc with:

assoc. w/ autoimmune diseases

HLA-DQ2, HLA-DQ8 (40% US)
APC-MHCII present gluten peptides

CD4+ T cell response
Ab to TTG

19

Tropical Spruce
-presentation
-dx
- tx

visit tropical areas → bacterial toxin or colonization of aerobic coliform bacteria → megaloblastic anemia from B12 + folate deficiency
- intestinal biopsy → villous flattening + travel hx
- antibiotics, B12, folate

20

small bowel bacterial overgrowth
- pathogenesis
- presentation

should be less than 10^5 organisms/mL, but get overgrowth w/
- anatomic abnormalities
- hypo-motility (diabetes, scleroderma, narcs)
- partial intestinal obstruction
- decreased acid secretion
- colon fistula-crohns


Overgrowth present with:
diarrhea/steatorrhea
abdom pain
bloating
weight loss
fat sol vitamin + B12 def
Normal/high folate level

21

small bowel bacterial overgrowth
dx:

aspiration of duodenum with culture
glucose-hydrogen breath test
- give pts glucose, measure H prod by bacteria
Antibiotics - 2 weeks cipro