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BMS150 Post-MT2 > Intestinal Pathology Part II > Flashcards

Intestinal Pathology Part II Flashcards

1
Q

80% of intestinal obstructions are due to what? (4)

A
  • Herniations
  • Adhesions
  • Intussusception
  • Volvulus
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2
Q

10-20% of intestinal obstructions are caused by what?

A

Tumors or infarcts

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3
Q

Intestinal obstruction is due to distention of the intestine caused by what?

A

Accumulation of gas and fluid proximal to and within the obstructed segment

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4
Q

With an intestinal obstruction, loss of fluid and electrolytes may be extreme, causing what? (3)

A
  • Hypovolemia
  • Renal insufficiency
  • Shock
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5
Q

What may fluid loss be from?

A
  • Vomiting
  • Accumulation of fluids in the lumen
  • Sequestration of fluid into the intestinal wall and peritoneal cavity
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6
Q

Where do most mechanical obstructions occur? Why?

A

Small bowel - smaller lumen, smaller diameter

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7
Q

Weakness or defect in the abdominal wall causing protrusion of peritoneum?

A

Hernia

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8
Q

What happens once the bowel has become trapped in a herniation? (5)

A
  • Venous outflow obstructed
  • Swelling of bowel
  • Increased intramural pressure
  • Decreased arterial perfusion
  • ISCHEMIC BOWEL
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9
Q

How are intestinal herniations named?

A

Based on location - inguinal, femoral, umbilical

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10
Q

Trapped bowel?

A

Incarceration

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11
Q

Trapped and ischemic bowel?

A

Strangulation

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12
Q

Most frequent cause of obstruction worldwide?

A

Intestinal herniation

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13
Q

Risk factors for intestinal hernia? (3)

A
  • Chronic cough
  • Chronic straining
  • Overweight
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14
Q

Clinical features of herniation? (4)

A
  • Acute or chronic pain
  • Bulges under the skin
  • Nausea and vomiting
  • Constipation
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15
Q

What usually occurs due to a tumor in the small bowel that disrupts motility?

A

Intussusception (telescoping)

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16
Q

What are usually due to an inflammatory process that link two segments of bowel together or compress it from the outside?

A

Adhesions

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17
Q

What are common causes of adhesions?

A
  • Crohn’s, diverticulitis
  • Abdominal surgery, cancers, infections
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18
Q

What tend to occur around a mesenteric point of attachment - both the vascular supply and the lumen are occluded at the site of twisting?

A

Volvulus

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19
Q

What presents similarly to a strangulated hernia and is a surgical emergency?

A

Severe acute mechanical obstruction

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20
Q

If blood flow is impaired, as in with a volvulus, it can cause mild hypoxia/ischemia and impaired function or __________

A

Food intolerance

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21
Q

Def. Ileus?

A

Bowel experiences greatly decreased motility - functional obstruction

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22
Q

Causes of functional bowel obstructions? (5)

A
  • Post-surgical
  • Intra-abdominal inflammation, hemorrhage, ischemia
  • Metabolic or electrolyte abnormalities
  • Medications that impair bowel motility
  • Sepsis or peritonitis
23
Q

What are some causes of Intestinal Ischemia? (5)

A
  • Atrial fibrillation, valvular disease, embolic disease
  • Hypercoagulable states
  • Global hyperfusion
  • Severe atherosclerosis
  • Post-vascular surgery
24
Q

Two phases of intestinal ischemia?

A
  1. Hypoxic injury
  2. Reperfusion injury
25
Hypoxic injury?
Epithelium, muscular layers are relatively resistant to ischemia, so damage is relatively limited early on
26
Reperfusion injury?
Free radical production, neutrophil infiltration, and release of inflammatory mediators, such as complement proteins and TNF = more severe damage
27
What do acute and complete arterial obstruction tend to cause?
Transmural infarction
28
What does coagulative necrosis cause?
Perforation and inflammation of the serosa or peritoneum
29
Vulnerable intestinal areas?
Watershed zones
30
Splenic flexure?
Where the superior and inferior mesenteric arterial circulations terminate
31
Sigmoid colon and rectum?
Where the inferior mesenteric, pudendal, and iliac arterial circulations terminate
32
Population that intestinal ischemia tends to occur in?
Older individuals with co-existing cardiac or vascular disease
33
Typical presentation of acute transmural infarction?
- Sudden, severe abdominal pain and tenderness - Nausea and vomiting - Bloody diarrhea - Grossly melanotic stool
34
Signs of intestinal ischemia overlap with what?
Acute appendicitis, perforated ulcer, and acute cholesystitis
35
Malformed submucosal and mucosal blood vessels?
Angiodysplasia
36
Where does angiodysplasia most often occur?
Cecum or right colon
37
Angiodysplasia accounts for ____ of major episodes of lower intestinal bleeding
20%
38
Pathogenesis of angiodysplasia contributing to mechanical and congenital factors?
- Focal dilation and tortuosity of overlying submucosal and mucosal vessels - Cecum develops greatest wall tension - Degenerative vascular changes
39
Clinical features of angiodysplasia?
- Hematochezia, melena, or iron deficiency - Often asymptomatic if bleeding mild
40
Most common abdominal surgical emergency?
Appendicitis
41
Major complication of appendicitis?
Perforation
42
Traditional model of appendicitis?
A fecalith obstructs the lumen of the appendix, resulting in bacterial and mucous "build up"
43
Appendicitis can lead to distention and ischemia, which may be severe enough to cause?
Gangrene
44
______ infiltrate the full thickness of the mucosa and ____ can accumulate and fill the appendiceal lumen
Neutrophils; pus
45
In cases of perforation, the wall “bursts” or leaks ______, ________, and _______ into the peritoneum causing peritonitis
Fecal material, mucous, and bacteria
46
Encapsulation of the appendix and leaked material can lead to?
Abscess formation (greater omentum may encapsulate the "mess")
47
"Free" perforation into the peritoneal cavity can cause? (4)
- 3rd spacing - Vascular collapse - Sepsis - Portal vein thrombosis (rare)
48
What else can cause appendicitis?
- Mesenteric adenitis (big lymph nodes) from IBD or infection - Cancer (rarely)
49
Appendicitis pain?
RLQ pain at McBurney’s point - often accompanied by nausea, vomiting, and anorexia
50
During pregnancy, where is appendix located?
RUQ
51
Symptoms of pelvic appendicitis?
Inguinal or suprapubic pain accompanied by dysuria. urinary frequency, diarrhea, tenesmus
52
Symptoms of perforation?
- High temp - Hypotension
53
Diagnosis of appendicitis?
CT (best sensitivity and specificity) or ultrasound
54
Treatment for appendicitis?
Immediate surgical removal

BMS150 Post-MT2 (17 decks)

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