PATH V

Question 1

brunners glands are where

Answer 1

duodenum

Question 2

where are peyers patches

Answer 2

ileum

Question 3

majority of GI obstructions are caused by

Answer 3

adhesions, hernias
volvulus
intussusception

Question 4

what are causes of pseudo obstructions

Answer 4

paralytic ileus
vascular- bowel infarction
myopathies and neuropathies (hirschsprung)

Question 5

signs of bowel obstruction

Answer 5

pain, distention, vomiting, constipation

Question 6

what will bowel obstruction show on XR

Answer 6

intestinal obstruction

Question 7

most common cause intestinal obstruction in US

Answer 7

adhesion between 2 loops of intestin

Question 8

most common cause intestinal obstruction in children <2 y.o

Answer 8

intussusception

Question 9

main cause of intussusception in adults

Answer 9

meckels

Question 10

most frequent cause intestinal obstruction worldwide

Answer 10

hernia (inguinal)

Question 11

what side are hernias moe likely

Answer 11

right side

Question 12

what does reducing a hernia mean

Answer 12

it can be manually pushed back into abdominal cavity

if cannot be reduced- incarcerated

Question 13

bent inner tube or coffee bean sign on abdominal XR could be what

Answer 13

sigmoid volvulus

Question 14

most likely places for volvulus

Answer 14

sigmoid colon, cecum, small bowel, stomach, large bowel

Question 15

reason for abdominal adhesions

Answer 15

post operative scar tissue, inflammation, endometriosis

Question 16

what intestinal vascular disorders can lead to GI bleeds

Answer 16

ischemic bowel disease
angiodysplasia
hemorrhoids

Question 17

what can cause lower intestinal bleeding

Answer 17

angiodysplasia, colonic carcinoma, IBD, rectosigmoid carcinoma, hemorrhoids, anal fissure

Question 18

what can cause SI bleeding

Answer 18

IBD, intussusception, meckel diverticulum

Question 19

how does the small intestine not suffer from chronic blood loss in a small artery

Answer 19

so many collaterals

Question 20

causes of Ischemic bowel disease

Answer 20

arterial embolism
aterial thrombosis
venous thrombosis
non-occlusive ischemia

Question 21

causes of arterial emboli

Answer 21

cardiac vegetation, angiography procedure, aortic atheroembolism, superior mesenteric most common

Question 22

where do arterial thrombosis take place in GI

Answer 22

superior mesenteric from atherosclerosis or systemic vasculitis, dissecting aneurysms

Question 23

what are causes of non occlusive ischemia in bowel

Answer 23

cardiac failure, shock, dehydration, vasoconstrictive drugs like cocaine, CMV infection

Question 24

what is a mural infarction? transmural?

Answer 24

mural is through muscularis mucosa and submucosa

transmural is where everything can leak across wall

Question 25

if there is full thickness infarction and necrosis of bowel wall how many days till perforation

Answer 25

1-4 days

Question 26

Sx of infarcted bowel

Answer 26

severe periumbilical pain | nausea and vomiting

Question 27

what does SMA supply

Answer 27

middle colon right colon, ileocolic aa

Question 28

IMA supplies

Answer 28

left colon, sigmoid and superior rectal artery

Question 29

what is the watershed zone of colon that is susceptible to ischemia

Answer 29

splenic flexure

Question 30

what is angiodysplasia

Answer 30

non neoplastic vascular lesion usually in cecum or proximal right colon tortuous dilation of malformed submucosal and mucosal blood vessels

Question 31

how common is angiodysplasia

Answer 31

20% significant lower intestinal bleeding

Question 32

what causes hemorrhoids

Answer 32

persistent elevation in venous pressure

Question 33

population with hemorrhoids

Answer 33

pregnant females unusual under 30 y.o common after 50 y.o cirrhosis assoc (portal HTN)

Question 34

most common cause hemorrhoids

Answer 34

straining at stool

Question 35

what is definition diarrhea

Answer 35

increase in stool mass, frequency and or fluifity | >200 gm/day

Question 36

what is dysentery

Answer 36

low volume, painful bloody diarrhea

Question 37

what is secretory diarrhea

Answer 37

>500mL isotonic fluid stoool persists during fasting infectious, viral or enterotoxin

Question 38

osmotic diarrhea

Answer 38

>500mL hypertonic fluid in stool stops with fasting lactase deficiency

Question 39

exudative diarrhea

Answer 39

mucosal damage causing purulent bloody stools persists during fasting bacterial or IBD

Question 40

derange motility diarrhea

Answer 40

improper neuromuscular fucntion variable during fasting neural hormonal or surgical

Question 41

what is the 72 hr stool fat test

Answer 41

patient on diet of 100 gm fat/day then stool collected for 3 days, if >18-21 gm fat then malabsorption

Question 42

malabsorption diarrhea

Answer 42

bulky with steatorrhea stops with fasting pale smelly floats celiac, giardia, CF, chronic pancreatitis

Question 43

what viruses cause secretory diarrhea

Answer 43

rotavirus, norovirus, enteric adenoviruses | astroviruses

Question 44

what infections that are enterotoxin mediated cause secretory diarrhea

Answer 44

vibrio cholerae E coli Bacillus cereus clostridium perfringens

Question 45

infectious causes of exudative diarrhea

Answer 45

shigella, salmonella, campylobacter, entamoeba histolytica

Question 46

infectious causes of malabsorptive diarrhea

Answer 46

giardia

Question 47

Sx infectious enterocolitis

Answer 47

diarrhea, abdominal pain, urgency, perianal discomfort, incontinence and hemorrhage

Question 48

what GI virus attack infants 6 mo-2 y.o

Answer 48

rotavirus group A

Question 49

what is second most common GI virus in US

Answer 49

norovirus

Question 50

histo features viral enteritis

Answer 50

increased intraepithelial, lamina propria lymphocytes and crypt hypertrophy

Question 51

Mech of bacterial enterocolitis

Answer 51

- ingestion of preformed toxin: staph, vibrio, C perfringens, C botulinum - infection by toxigenic organisms: e coli, v cholerae, campylobacter - infection by enteroinvasive organisms: shigella, salmonella, campylobacter, enteroinvasive E coli

Question 52

complications of campylobacter enterocolitis

Answer 52

arthritis, guillain barre syndrome