Flashcards in 49. Other intestinal disorders Deck (35)
acute mesenteric ischemia - efintion / mechanism
critical blocage of intestinal blood flow ( often embolus to SMA ) --> smal bowel necrosis
acute mesenteric ischemia - presentation
1. abdominal pain out of proportion of physcial findings
2. red currant jelly stools
3. decreased sounds
chronic mesenteric ischemia - mechanism and presentation
" intestinal angina : : atherosclerosis of celiac artery SMA, or IMA --> intestinal hypoperfusion --> postpradial epigastric pain --> food aversion and weight loss
ischemic colitis - mechanism / presentation
reduction in intestinal blood flow --> crampy abdominal pain followed by hematoscezia
ischemic colitis - location and epidemiology
commonly occurs at watershed areas : splenic flexure, distal colon
Typically affects elderly
angiodysplasia - definition, presentation, location
acquired torturous dilation of vessels --> hematoscezia
MC often in cecum , terminal ileum, ascending colon
Angiodysplasia - diagnosis , epidemiology
More common in older / diagnosis with angiography
MCC of small bowel obstruction
bowel adhesion - definition / due to / apperance
fibrous band od scar tissue, commonly forms after surgery. they can have well demarcated necrotic zones
illeus - definition/ presentation
intestinal hypomotility without obstruction -->
1. constipation and decreased flatus
2. distended / tympanic abdomen
3. decreased bowel sounds
illeus - may be due to
1. abdominal surgeries
3. Low K+
1. bowel rest
2. electrolyte correction
3. cholinergic drugs ( stimulate intestinal motility)
Meconium ileus ?
in cystic fibrosis, meconium plags obstructs intestine , preventing stool passage at birth
necrotizing enterocolitis ?
necrosis of intestinal mucosa ( primary colonic) with possible perforation, which can lead to pneumatosis ( gas into the wall), free air in abdomen, portal venous gas
necrotizing enterocolitis seen in
premature, folmula-fed infants ( no brestfeed ) with immature immune system
• A newborn with bilious vomiting since birth has a distended abdomen. What is the likely diagnosis?
• A baby w/bilious vomiting has an X-ray to look for failure of recanalization in development. What finding do you look for to confirm this?
"Double bubble" sign (the bubbles are the stomach and the duodenum proximal to the atresia) (this is duodenal atresia)
• A newborn presents with early bilious vomiting and a "double bubble" on X-ray. What chromosomal abnormality is associated with his disease?
Trisomy 21 (Down syndrome) (this newborn likely has duodenal atresia, which is associated with this chromosomal abnormality)
• Meconium ileus due to cystic fibrosis, which runs in families and is associated with pneumonia due to inability to clear mucous secretions
• Which patients are most at risk for necrotizing enterocolitis?
Premature neonates because of their decreased immunity, & formula feeding also increases risk
• A premature infant develops feeding intolerance; he has a distended abdomen and pneumatosis on x-ray. He has no bilious vomiting. Diagnosis?
• Where does ischemic colitis commonly occur?
The splenic flexure and distal colon (watershed areas between arterial territories that therefore have tenuous blood flow)
• An 80-year-old man with CAD presents has 6 months of weight loss due to pain after eating. Where do you suspect the pain is occurring?
The splenic flexure (LUQ) or distal colon (LLQ) (this is ischemic colitis, which affects watershed areas)
• What is a common complaint of patients with ischemic colitis?
Pain after eating (increased metabolic demand in intestines and inability to appropriately increase blood flow leads to an ischemic state)
• An elderly patient has painless hematochezia. After colonoscopy fails to detect any neoplasms, what test can confirm the most likely cause?
Angiography, as the most likely cause of the painless bleeding is angiodysplasia
• Where is angiodysplasia typically found in the gastrointestinal tract?
Cecum, terminal ileum, ascending colon
• A 70-year-old man complains of bright-red blood per rectum. Angiography shows tortuous dilation of vessels at the bleeding site. Diagnosis?
• A patient with angiodysplasia will typically complain of what symptoms?
Hematochezia, due to bleeding from tortuous dilation of vessels
• Is angiodysplasia more common in children, young adults, or the elderly?
• A 48-y/o man with many past abdominal surgeries has a distended abdomen with decreased bowel sounds. What does this patient likely have?
Ileus, or intestinal hypomotility without obstruction
• An opiate abuser complains of increased constipation and decreased flatus. On CT, no obstructions are noted. What does he have?
Ileus (intestinal hypomotility without obstruction
• A recent abdominal surgery patient has stomach pain and vomiting. Laparotomy is performed and adhesions are seen. What do you see grossly?
Adhesions that are symptomatic may demonstrate well-demarcated necrotic zones
• A man with a history of heart disease has abdominal pain and red “currant jelly” stools. Do you limit your differential to intussusception?
No, as acute mesenteric ischemia may also present with red “currant jelly” stools
• A patient with sepsis is diagnosed with intestinal hypomotility without obstruction. What treatment options may be of use for this patient?
Treat with bowel rest, electrolyte correction, and cholinergic drugs to stimulate intestinal motility (this is ileus)