49. Other intestinal disorders Flashcards Preview

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Flashcards in 49. Other intestinal disorders Deck (35):
1

acute mesenteric ischemia - efintion / mechanism

critical blocage of intestinal blood flow ( often embolus to SMA ) --> smal bowel necrosis

2

acute mesenteric ischemia - presentation

1. abdominal pain out of proportion of physcial findings
2. red currant jelly stools
3. decreased sounds

3

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

4

ischemic colitis - mechanism / presentation

reduction in intestinal blood flow --> crampy abdominal pain followed by hematoscezia

5

ischemic colitis - location and epidemiology

commonly occurs at watershed areas : splenic flexure, distal colon
Typically affects elderly

6

angiodysplasia - definition, presentation, location

acquired torturous dilation of vessels --> hematoscezia
MC often in cecum , terminal ileum, ascending colon

7

Angiodysplasia - diagnosis , epidemiology

More common in older / diagnosis with angiography

8

MCC of small bowel obstruction

adhesion

9

bowel adhesion - definition / due to / apperance

fibrous band od scar tissue, commonly forms after surgery. they can have well demarcated necrotic zones

10

illeus - definition/ presentation

intestinal hypomotility without obstruction -->
1. constipation and decreased flatus
2. distended / tympanic abdomen
3. decreased bowel sounds

11

illeus - may be due to

1. abdominal surgeries
2. opiates
3. Low K+
4. sepsis

12

illeus treatment

1. bowel rest
2. electrolyte correction
3. cholinergic drugs ( stimulate intestinal motility)

13

Meconium ileus ?

in cystic fibrosis, meconium plags obstructs intestine , preventing stool passage at birth

14

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

15

necrotizing enterocolitis seen in

premature, folmula-fed infants ( no brestfeed ) with immature immune system

16

• A newborn with bilious vomiting since birth has a distended abdomen. What is the likely diagnosis?

Duodenal atresia

17

• 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)

18

• 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)

19

• Meconium ileus due to cystic fibrosis, which runs in families and is associated with pneumonia due to inability to clear mucous secretions

.

20

• Which patients are most at risk for necrotizing enterocolitis?

Premature neonates because of their decreased immunity, & formula feeding also increases risk

21

• A premature infant develops feeding intolerance; he has a distended abdomen and pneumatosis on x-ray. He has no bilious vomiting. Diagnosis?

Necrotizing enterocolitis

22

• Where does ischemic colitis commonly occur?

The splenic flexure and distal colon (watershed areas between arterial territories that therefore have tenuous blood flow)

23

• 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)

24

• 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)

25

• 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

26

• Where is angiodysplasia typically found in the gastrointestinal tract?

Cecum, terminal ileum, ascending colon

27

• A 70-year-old man complains of bright-red blood per rectum. Angiography shows tortuous dilation of vessels at the bleeding site. Diagnosis?

Angiodysplasia

28

• A patient with angiodysplasia will typically complain of what symptoms?

Hematochezia, due to bleeding from tortuous dilation of vessels

29

• Is angiodysplasia more common in children, young adults, or the elderly?

The elderly

30

• 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

31

• 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

32

• 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

33

• 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

34

• 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)

35

• The elderly)
• Abdominal surgeries, opiates, hypokalemia, sepsis
• Signs of perforation including pneumatosis intestinalis, free air in the abdomen, portal venous gas

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