SFP: developmental anomalies, vascular disorders, obstruction, diverticulosis

Question 1

Describe malrotation of the large intestine

Answer 1

Incorrect rotation of the GI tract can result in the cecum in the upper quadrant instead of the lower quadrant. This can result in fibrous band formation that may cause obstruction.

Question 2

Describe annular pancreas

Answer 2

A failure of clockwise rotation of the ventral pancreas results in the pancreas encircling the upper duodenum.

Question 3

Describe duodenal atresia

Answer 3

A failure to recanalize causes a double bubble looking structure of the duodenum, due to a fibrous band-like structure with no lumen.

Question 4

What are symptoms of duodenal atresia?

Answer 4

Abdominal distention, vomiting, no passage of meconium.

Question 5

When do symptoms of duodenal atresia begin?

Answer 5

Immediately after birth.

Question 6

Describe jejunal, ileal, and colonic atresia

Answer 6

Less common form of atresia caused by inadequate supply of blood to the intestines during development.

Question 7

Describe Meckel’s diverticulum

Answer 7

Incomplete obliteration of the vitelline duct (connection between small bowel and umbilicus).

Question 8

Describe the location/structure of the lesion in Meckel’s diverticulum

Answer 8

It is about 2 ft from the ileocecal valve, 2 inches in length.

Question 9

When does Meckel’s diverticulum begin to show symptoms?

Answer 9

2 years after birth - Later in life.

Question 10

Describe histology of Meckel’s diverticulum

Answer 10

Two mucosae: gastric and pancreatic. The increased acidity from these mucosal types may cause signs of inflammation.

Question 11

Describe an omphalocele

Answer 11

Persistence of herniation of abdominal content into the umbilical cord and sealed by peritoneum.

Question 12

What causes an omphalocele?

Answer 12

Incorrect rotation of the bowel when it returns to the abdomen.

Question 13

What genetic issues are associated with an omphalocele?

Answer 13

Trisomy 13, 18, 21.

Question 14

What is gastroschisis?

Answer 14

Abdominal content extrusion lateral to umbilicus and not covered by peritoneum.

Question 15

Describe Hirschsprung’s disease

Answer 15

A congenital megacolon (dilated with thin wall) due to an absence of ganglion cells distal to the dilated segment.

Question 16

What is seen histologically in Hirschsprung’s disease?

Answer 16

Neural hyperplasia, nerve hypertrophy, no ganglion cells in the stroma.

Question 17

Describe an ischemic small bowel

Answer 17

A dark red infarcted small intestine due to blood supply being cut off; this could lead to necrosis.

Question 18

What might cause small bowel ischemia?

Answer 18

Shock, emboli, atherosclerosis, obstruction, trauma.

Question 19

What is seen histologically in ischemic small intestine?

Answer 19

Atrophic crypts, hemorrhage, fibrin, necroinflammatory debris.

Question 20

Describe angiodysplasia

Answer 20

Tortuous, dilated vessels in the submucosa that lead to hemorrhage and bleeding.

Question 21

What are hemorrhoids?

Answer 21

Swollen and dilated veins in the anorectal region caused by straining and constipation; may be internal or external.

Question 22

What are diverticuli?

Answer 22

Outpouching of the mucosa and submucosa through the muscularis.

Question 23

What are the most common sites of diverticuli?

Answer 23

Sigmoid colon/left colon.

Question 24

What are possible outcomes of diverticuli?

Answer 24

Fecal matter can get stuck in the outpouchings and lead to inflammation or possibly perforation.

Question 25

What are the major causes of obstruction?

Answer 25

Herniation, adhesion, intussusception, volvulus.

Question 26

What is an inguinal hernia?

Answer 26

Protrusion of abdominal contents through the inguinal canal.

Question 27

Compare indirect and direct inguinal hernia

Answer 27

Indirect hernias go through the deep and superficial rings and are lateral to the inferior epigastric vessels. Direct hernias protrude through a weakened area of fascia directly behind the superficial ring and are medial to inferior epigastric vessels. These also rarely enter the scrotum, whereas indirect hernias can.

Question 28

Describe adhesions

Answer 28

Irregular bands of scar tissue that may be due to previous surgery, infection, trauma, or radiation. These bands connect various bowel segments that can cause obstruction.

Question 29

What is intussusception?

Answer 29

Small bowel found within the colon.

Question 30

What is volvulus?

Answer 30

A twisting of the small or large intestine. The blood supply also gets twisted, which may cut off supply to the area and lead to complete necrosis.

Question 31

Where does inflammation begin in acute appendicitis?

Answer 31

The mucosa.

Question 32

What is seen grossly in acute appendicitis?

Answer 32

Swollen appendix with white exudates on the surface, necrosis in the lumen, inflammation in the mucosa.

Question 33

What is seen histologically in acute appendicitis?

Answer 33

Necroinflammatory debris, transmural inflammation, neutrophils.

Question 34

What is paralytic ileus?

Answer 34

Nerve or muscle issues lead to slowed or stopped contractions of the intestine. The movement of food and fluid is impacted without the presence of mechanical obstruction.

Question 35

What is meconium ileus?

Answer 35

In a newborn, meconium (greenish material) gets stuck in the distal small intestine, leading to obstruction, distention, and possibly perforation.

Question 36

What is a main cause of meconium ileus?

Answer 36

CF.

Question 37

What are diagnostic markers of meconium ileus?

Answer 37

Soap bubble appearance on x-ray and empty rectum.

Question 38

What is rectal prolapse?

Answer 38

Rectum protrudes through the anal canal.

Question 39

What causes rectal prolapse?

Answer 39

Diverticular disease, straining, colonic spastic contractions.

Question 40

What are outcomes of rectal prolapse?

Answer 40

Ulceration of mucosa, ischemia or necrosis from impacted blood supply, damage to the sphincter muscle.

Question 41

What is seen histologically in rectal prolapse?

Answer 41

Hypertrophic smooth muscle in the stroma, erosion/inflammation of mucosa, hyperplastic and serrated changes.