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GI > Pathology- the small bowl > Flashcards

Pathology- the small bowl Flashcards

1
Q

What is the small bowl

A

the small intestine

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2
Q

what is the innermost cell of the small bowl

A

enterocytes lined with villi

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3
Q

what is the main function of the villi

A

absroption

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4
Q

what is the blood supply to the small bowl

A

entire supply from superior mesenteric

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5
Q

what can cause ischaemia of the small bowl

A

mesenteric artery occlusion

non occlusive perfusion insufficiency

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6
Q

what can cause mesenteric artery occlusion

A

mesenteric artery atherosclerosis

thromboembolism from heart (e.g. A fib)

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7
Q

what can cause a non occlusive perfusion insufficiency

A

shock (when haemorrhaging as brain, heart and lungs a priority)

strangulation obstructing venous return (e.g. hernia or adhesion)

drugs (e.g. cocaine, causes spasm of intestinal wall)

hyperviscosity

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8
Q

what pain is associated with ischaemia of the small bowl

A

acute pain as usually acute, can by chronic

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9
Q

why is the mucosa the area most affected by an infarction (the effects of hypoxia)

A

as it is the most metabolically active area

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10
Q

what increases with the period of hypoxia

A

the greater the dept of the damage to the bowl wall and likelyhood of complications

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11
Q

in non occlusive ischaemia when does much of the tissue damage occur

A

after reperfusion

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12
Q

what is a possible outcome from the following

  • mucosa infarct
  • mural infarct
  • transmural infarct
A

different types of infarct occur as the length og time of ischaemia increases. the outcomes also get worse

  • regeneration
  • stricture (abnormal narrowing caused by firbous scarring during healing)
  • gangrene (when infarct goes through the bowl)
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13
Q

what are the complications of ischaemia of the small bowl

A

mucosa
resolution

mural
fibrosis, stricture, chronic ischaemia, mesenteric angina, obstruction,

transmural
gangrene, perforation, peritonitis, sepsis, death

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14
Q

what is meckel’s diverticulum

A

is a result of imcomplete regression of vitello-intestinal duct (embryological feature)

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15
Q

describe meckels diverticulum

A

Tubular structure, 2 inches long, 2 foot above IC (illeocecal) valve in 2% of people

May contain heterotopic gastric mucosa

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16
Q

what can a mekels diverticulum cause

A

bleeding, perforation or diverticulitis which mimicks appendicitis, peptic ulcers

Commonly assymptomatic, incidental finding

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17
Q

what tumours are most common in the small bowel

A 
primary tumours rare 
secondary tumours (metastases from ovary, colon and stomach) more common 
primary tumours include 
-lymphomas
-carcinoid tumours
-carcinomas
(in order of commonness)
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18
Q

what type are the lymphomas of the bowel

A

non hodkins in type

19
Q

how are lymphomas of the bowel treated

A

surgery and chemotherapy

20
Q

where is the most common site for a carcinoid tumour in the small bowl

A

the appendix

21
Q

describe carcinoid tumours of the bowel

A

small, yellow, small growing, locally invasive, produces hormone like substances, if metastases to liver causes a carcinoid tumour producing flushing, diarrhoea and head aches

22
Q

what cancer is associated with coeliac disease

A

lymphomas

23
Q

describe carcinomas of the small bowel

A

rare, presents late, metastases to lymph nodes and liver occur

24
Q

what bowl cancer is associated to crohns and coeliac disease

A

carcinoma (as they are predisposed to rarer cancers)

25
Q

what are the symptoms of an appendicitis

A

vomiting, abdominal pain, right illiac fossa, increased white cell count

26
Q

what can cause an cute appendicitis

A

unknown (most common), faecoliths (dehydration), lymphoid hyperplasia, parasites, tumours (rare)

27
Q

describe the pathology of an acute appendicitis

A

Acute inflammation (neutrophils)- must involve a muscle coat

Mucosal ulceration

Serosal congestion, exudate

Pus in lumen

28
Q

what happens to the wall of the appendix during an acute appendicitis

A

is thickened, neutrophils invade it, inflammation

29
Q

what are the complications of an appendicitis

A

peritonitis, rupture, abscess, fistula, sepsis and liver abscess

30
Q

how can an acute appendicitis cause a liver abscess

A

can spread to liver via portal system causing abscess of liver

31
Q

what is coeliac disease caused by

A

an abnormal reaction to a constituent of wheat flour, gluten, which damages enterocytes and reduces absorptive capacity- damages villi

32
Q

when can coeliac disease present

A

any time

33
Q

what is coeliac disease strongly associated with

A

HLA-B8, dermatitis herpeformis, childhood diabetes

34
Q

what is the suspected auto antigen (toxic agent) in coeliac disease

A

gliadin (component of gluten)

-tissue injury may be a bystander effect of abnormal immune reaction to Gliadin

35
Q

what is T cells role in coeliac disease

A

Mediated by T-cell lymphocytes which exist within the small intestinal epithelium ‘intraepithelial lymphocytes’ (IELS)

36
Q

what is the normal lifespan of an enterocyte

A

72 hours

37
Q

how is coeliac disease seen in the gut

A

increasing loss of enterocytes due to IEL mediated damage
This leads to loss of villous structure, loss of surface area,
a reduction in absorbtion and a flat duodenal mucosa

(e.g. flat mucosal biopsy with total villous atropy)

38
Q

what is the morphology of coeliac disease

A

increased inflammation in lamina propria, increased intraepithelial lmphocytes

39
Q

what part of the bowl is usually worse in coeliac disease

A

proximal

40
Q

what antibodies will be found in someone with coeliac disease

A

anti-TTG, anti-endomesial, anti glandin

41
Q

what are the metabolic effects of coeliac disease

A

Malabsorbtion of sugars, fats, amino acids, water and electrolytes

Malabsorbtion of fats leads to steatorrhea (excessive fat in poo)

Reduced intestinal hormone production leads to reduced pancreatic secretion and bile flow (CCK) leading to gallstones

42
Q

what are the clinical effects of malabsorption

A

weight loss, anaemia, abdominal bloating, failure to thrive, vitamin deficiencies

43
Q

what are 4 rare complications of coeliac disease

A

T-cell lymphomas of GI tract
Increased risk of small bowel carcinoma
Gall stones
Ulcerative-jejenoilleitis

GI (64 decks)

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