Pathology of the Small Intestine - Week 2

Question 1

Give some causes of small bowel ischaemia.

Answer 1

Mesenteric artery atherosclerosis
Thromboembolism from heart (e.g. A.Fib)
Shock eg. haemorrhage
Strangulation obstructing venous return (e.g. hernia, adhesion)
Drugs e.g. Cocaine
Hyperviscosity

Question 2

Which part of the bowel is most prone to hypoxia?

Answer 2

Mucosa

Question 3

What are the 3 types of small bowel ischaemia?

Answer 3

Mucosal, mural or transmural

Question 4

What are some complications of small bowel ischaemia?

Answer 4

Fibrosis, stricture, chronic ischaemia, ‘mesenteric angina’ and obstruction
Gangrene , perforation, peritonitis, sepsis and death

Question 5

What is meant by Meckel’s Diverticulum and what complications may this involve?

Answer 5

Tubular structure, 2 inches long, 2 foot above IC valve in 2% of people which may contain gastric mucosa. Inflammation/peptic ulcer in this may result in pain which mimicks appendicitis.

Question 6

Which tumours are common in the small intestine?

Answer 6

Secondary tumours/metastases of Ovary, Colon, Stomach - primary tumours are rare

Question 7

What are the 3 types of primary tumour found in the small intestine?

Answer 7

Lymphomas
Carcinoid (neuroendocrine) tumours
Carcinomas

Question 8

Which lymphomas are more common in the small intestine?

Answer 8

Non-Hodgkins

Question 9

Which condition can result in lymphoma in the small intestine?

Answer 9

Coeliac disease

Question 10

Where is the most common site of carcinoid (neuroendocrine) tumours in the small intestine?

Answer 10

Appendix

Question 11

Carcinoma of the small bowel is associated with…

Answer 11

Coeliac disease & Crohn’s disease

Question 12

Give some causes of appendicitis.

Answer 12

Unknown
Faecoliths (dehydration)
Lymphoid hyperplasia
Parasites
Tumours (rare)

Question 13

Explain the pathology of acute appendicitis.

Answer 13

Acute inflammation (neutrophils)
Mucosal ulceration
Serosal congestion, exudate
Pus in lumen

Question 14

Give some potential complications of appendicitis.

Answer 14

Peritonitis
Rupture 
Abscess
Fistula
Sepsis and liver abscess

Question 15

Which other conditions are strongly associated with Coeliac disease?

Answer 15

dermatitis herpetiformis, HIV, Type 1 Diabetes

Question 16

What is the suspected toxic agent of gluten?

Answer 16

Gliadin

Question 17

Reduced intestinal hormone production in Coeliac disease leads to reduced pancreatic secretion and bile flow (CCK) leading to…

Answer 17

Gallstones

Question 18

Give some effects of malabsorption secondary to Coeliac disease.

Answer 18

Loss of weight
Anaemia (Fe, Vit B12, Folate)
Abdominal bloating
Failure to thrive
Vitamin deficiencies