Flashcards in EXAM #1: SMALL BOWEL PATHOLOGY II Deck (42)
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1
Q
What is diverticulosis?
A
Outpouching of the intestinal wall (mucosa and submucosa through the muscularis propria)
2
Q
What is diverticulitis?
A
Inflammation of an outpouching of the intestinal wall
3
Q
Which is more associated with bleeding, diverticulosis or diverticulitis?
A
Diverticulosis
4
Q
Describe the pathogenesis diverticular disease.
A
- Focal weakness in colonic wall caused by:
1) Increased luminal pressure
2) Low fiber diet
- Focal weakness where vasa recta enter muscularis propria
1) Increased luminal pressure
2) Low fiber diet
- Focal weakness where vasa recta enter muscularis propria
5
Q
What intestinal wall layer is absent that leads to development of diverticula?
A
Muscularis propria
6
Q
Where are most diverticula located?
A
Sigmoid colon
7
Q
How do multiple diverticula appear on a barium enema?
A
"Sawtooth"
8
Q
What are the complications of diverticular disease?
A
1) Inflammation i.e diverticulitis
2) Perforation
3) Abscess formation
4) Rupture
5) Fistula tract formation
2) Perforation
3) Abscess formation
4) Rupture
5) Fistula tract formation
9
Q
What are the symptoms of diverticular disease?
A
- Abdominal cramping
- Lower abdominal pain
- Sensation of not being able to empty rectum
- Lower abdominal pain
- Sensation of not being able to empty rectum
10
Q
What part of the bowel is most commonly affected by intestinal obstruction?
A
Small bowel
11
Q
What are the symptoms of intestinal obstruction?
A
- Pain
- Distention
- Vomiting
- Constipation
- Failure to pass gas
- Distention
- Vomiting
- Constipation
- Failure to pass gas
12
Q
What causes most of the cases of intestinal obstruction?
A
1) Hernia
2) Adhesions
3) Intussusception*
4) Volvulus*
*These are medical emergencies
2) Adhesions
3) Intussusception*
4) Volvulus*
*These are medical emergencies
13
Q
What is a hernia?
A
Outpouching of the peritoneum through a defect in the abdominal wall
14
Q
What are the major complications of hernias?
A
1) Strangulation
2) Incarceration
*This is a medical emergency when it occurs*
2) Incarceration
*This is a medical emergency when it occurs*
15
Q
What is an inguinal hernia?
A
Portion of the small intestine enters the inguinal hernia
16
Q
What is a direct inguinal hernia?
A
Medial to the inferior epigastric artery
17
Q
What is an indirect inguinal hernia?
A
Lateral to the inferior epigastric artery
- Through inguinal canal
- In testes
- Through inguinal canal
- In testes
18
Q
What are "adhesions?"
A
Fibrous bridges between bowel segments or abdominal wall
19
Q
What are adhesions associated with?
A
1) Inflammation i.e. peritonitis
2) Surgery
3) Infection
4) Endometriosis
2) Surgery
3) Infection
4) Endometriosis
20
Q
What is the major complication of adhesions?
A
Bowel slips between fibrous bridges resulting in:
- Obstruction
- Infarction
****Note this is called an internal hernia*****
- Obstruction
- Infarction
****Note this is called an internal hernia*****
21
Q
What is Intussusception?
A
Telescoping of one segment of bowel into an immediately distal segment
22
Q
What causes intussusception in kids?
A
1) Secondary lymphoid hyperplasia
2) Rotavirus
2) Rotavirus
23
Q
What causes intussusception in adults?
A
1) Mass
2) Tumor
2) Tumor
24
Q
What are the major complications of Intussusception?
A
- Obstruction
- Infarction (mesenteric vessels become trapped)
- Infarction (mesenteric vessels become trapped)
25
Q
What is volvulus?
A
Complete twisting of a loop of bowel
26
Q
What are secondary causes of bowel obstruction?
A
1) Foreign body (drug mule)
2) Carcinoma
2) Carcinoma
27
Q
How does malabsorption present in kids?
A
- Diarrhea
- Failure to thrive
- Failure to thrive
28
Q
What type of stool change is typical of malabsorption?
A
Steatorrhea
29
Q
What are the three phases of nutrient absorption?
A
1) Intraluminal digestion (saliva, gastric enzymes, pancreatic enzymes...etc.)
2) Terminal digestion (hydrolysis at the brush border)
3) Transepithelial transport
2) Terminal digestion (hydrolysis at the brush border)
3) Transepithelial transport
30
Q
What are the three most common malabsorptive disorders in the US?
A
1) Celiac sprue
2) Chronic pancreatitis
3) Crohn's Disease
2) Chronic pancreatitis
3) Crohn's Disease
31
Q
What is Celiac spure?
A
Gluten sensitive enteropathy
32
Q
What is the component of gluten that causes an inflammatory reaction?
A
Gliadin
33
Q
What cells mediate the inflammation seen in Celiac Sprue?
A
T-cells
34
Q
What is the hallmark characteristic of a mucosal biopsy in Celiac Sprue?
A
Proximal villous atrophy
- Preceeded by villous blunting
- Preceeded by villous blunting
35
Q
What are patients with Celiac Spure at risk of?
A
Malignancy
36
Q
What is Tropical Sprue?
A
Tropical disease--bacterial infection
37
Q
In Tropical Spure, what is one major complication related to the fact that the entire small bowel is affected?
A
- Folate/B12 deficiency
- Megaloblastic changes
- Megaloblastic changes
38
Q
How is Tropical Sprue treated?
A
Broad spectrum antibiotics
39
Q
What is Whipple Disease?
A
Rare systemic infectious disease caused by the bacterium Tropheryma whipplei
40
Q
What is the hallmark of Whipple Disease?
A
Macrophages stuffed with PAS+ granules in multiple organ systems
41
Q
What are the clinical features of Whipple Disease?
A
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.
- 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
Q
How is Whipple Disease treated?
A
Antibiotics
