EXAM #1: SMALL BOWEL PATHOLOGY II Flashcards Preview

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Flashcards in EXAM #1: SMALL BOWEL PATHOLOGY II Deck (42):
1

What is diverticulosis?

Outpouching of the intestinal wall (mucosa and submucosa through the muscularis propria)

2

What is diverticulitis?

Inflammation of an outpouching of the intestinal wall

3

Which is more associated with bleeding, diverticulosis or diverticulitis?

Diverticulosis

4

Describe the pathogenesis diverticular disease.

- Focal weakness in colonic wall caused by:
1) Increased luminal pressure
2) Low fiber diet
- Focal weakness where vasa recta enter muscularis propria

5

What intestinal wall layer is absent that leads to development of diverticula?

Muscularis propria

6

Where are most diverticula located?

Sigmoid colon

7

How do multiple diverticula appear on a barium enema?

"Sawtooth"

8

What are the complications of diverticular disease?

1) Inflammation i.e diverticulitis
2) Perforation
3) Abscess formation
4) Rupture
5) Fistula tract formation

9

What are the symptoms of diverticular disease?

- Abdominal cramping
- Lower abdominal pain
- Sensation of not being able to empty rectum

10

What part of the bowel is most commonly affected by intestinal obstruction?

Small bowel

11

What are the symptoms of intestinal obstruction?

- Pain
- Distention
- Vomiting
- Constipation
- Failure to pass gas

12

What causes most of the cases of intestinal obstruction?

1) Hernia
2) Adhesions
3) Intussusception*
4) Volvulus*

*These are medical emergencies

13

What is a hernia?

Outpouching of the peritoneum through a defect in the abdominal wall

14

What are the major complications of hernias?

1) Strangulation
2) Incarceration

*This is a medical emergency when it occurs*

15

What is an inguinal hernia?

Portion of the small intestine enters the inguinal hernia

16

What is a direct inguinal hernia?

Medial to the inferior epigastric artery

17

What is an indirect inguinal hernia?

Lateral to the inferior epigastric artery
- Through inguinal canal
- In testes

18

What are "adhesions?"

Fibrous bridges between bowel segments or abdominal wall

19

What are adhesions associated with?

1) Inflammation i.e. peritonitis
2) Surgery
3) Infection
4) Endometriosis

20

What is the major complication of adhesions?

Bowel slips between fibrous bridges resulting in:
- Obstruction
- Infarction

****Note this is called an internal hernia*****

21

What is Intussusception?

Telescoping of one segment of bowel into an immediately distal segment

22

What causes intussusception in kids?

1) Secondary lymphoid hyperplasia
2) Rotavirus

23

What causes intussusception in adults?

1) Mass
2) Tumor

24

What are the major complications of Intussusception?

- Obstruction
- Infarction (mesenteric vessels become trapped)

25

What is volvulus?

Complete twisting of a loop of bowel

26

What are secondary causes of bowel obstruction?

1) Foreign body (drug mule)
2) Carcinoma

27

How does malabsorption present in kids?

- Diarrhea
- Failure to thrive

28

What type of stool change is typical of malabsorption?

Steatorrhea

29

What are the three phases of nutrient absorption?

1) Intraluminal digestion (saliva, gastric enzymes, pancreatic enzymes...etc.)
2) Terminal digestion (hydrolysis at the brush border)
3) Transepithelial transport

30

What are the three most common malabsorptive disorders in the US?

1) Celiac sprue
2) Chronic pancreatitis
3) Crohn's Disease

31

What is Celiac spure?

Gluten sensitive enteropathy

32

What is the component of gluten that causes an inflammatory reaction?

Gliadin

33

What cells mediate the inflammation seen in Celiac Sprue?

T-cells

34

What is the hallmark characteristic of a mucosal biopsy in Celiac Sprue?

Proximal villous atrophy
- Preceeded by villous blunting

35

What are patients with Celiac Spure at risk of?

Malignancy

36

What is Tropical Sprue?

Tropical disease--bacterial infection

37

In Tropical Spure, what is one major complication related to the fact that the entire small bowel is affected?

- Folate/B12 deficiency
- Megaloblastic changes

38

How is Tropical Sprue treated?

Broad spectrum antibiotics

39

What is Whipple Disease?

Rare systemic infectious disease caused by the bacterium Tropheryma whipplei

40

What is the hallmark of Whipple Disease?

Macrophages stuffed with PAS+ granules in multiple organ systems

41

What are the clinical features of Whipple Disease?

Fat malabsorption and steatorrhea
- Macrophages compress lacteals (lymphatic vessels of the small intestine that absorb digested fats)
- Chylomicrons cannot be transferred from enterocytes to lymphatics

****Note that Whipple Disease also involves the cardiac valves, lymph nodes, and CNS.

42

How is Whipple Disease treated?

Antibiotics