small bowel

Question 1

what 2 types of ischaemia are there

Answer 1

mesenteric arterial occlusion

non occlusive perfusion insufficiency

Question 2

what can cause ischaemia

Answer 2

mesenteric artery atherosclerosis
thromboembolus from heart 
shock
strangulation
drugs e.g cocaine
hyperviscosity

Question 3

which part of the small bowel is most metabolically active and therefore most sensitive to ischaemia

Answer 3

mucosa

Question 4

what is Meckel’s diverticulum

Answer 4

incomplete regression of vietello intestinal duct

Question 5

how can a Meckel’s diverticulum mimic appendicitis

Answer 5

it may contain heterotropic gastic mucosa which can release acid
it can cause bleeding, perforation or diverticulitis which mimicks appendicitis
commonly asymptomatic

Question 6

are primary tumours of the small bowel common

Answer 6

no they are very rare

Question 7

what type of tumours can you get in the small bowel

Answer 7

lymphomas
carcinomas
carcinoid tumours

Question 8

what are carcinomas of the small bowel associated with

Answer 8

crohns disease and coeliac disease

Question 9

what is coeliac disease and how does it affect enterocytes

Answer 9

autoimmune disease

abnormal reaction to a constituent of wheat flour, guten which damages enterocytes and reduced absorptive capacity

Question 10

coeliac disease has an association to what gene

Answer 10

HLA-B8

Question 11

what are some of the compliation with coeliac disease

Answer 11

T cell lymphoma of the GI tract
increased risk of small bowel carcinoma
Gall stones
ulcerative jejenoilleitis

Question 12

what is the suspected component of gluten that is toxic

Answer 12

gliadin

Question 13

what happens to the cells in coeliac disease

Answer 13

increasing loss of enterocytes
loss of villus structure SA, reduction in absorption and a flat duodenal mucosa
inflammation in lamina propria
increased intraepithelial lymphocytes

Question 14

what are metabolic effects of coeliac disease

Answer 14

malabsorption of all nutrients
steatorrhoea (excess fat in faeces)
reduced pancreatic secretion and bile flow-gallstones

Question 15

in terms of pathology what happens in acute appendicitis

Answer 15

acute inflammation (neutrophils)
mucosal ulceration
serosal congestion, exudate
pus in lumen

Question 16

which has a lower protein content exudate or transudate

Answer 16

transudate

Question 17

in non occlusive ischaemia when does most damage occur

Answer 17

after reperfusion

Question 18

when would you get type 1 intestinal failure

Answer 18

self-limiting short term

post operative ileus

Question 19

when would you get type 2 intestinal failure

Answer 19

prolonged, associated with sepsis and metabolic complications. often reated to abdominal surgery with complications

Question 20

what types of diseases are associated with type 3 intestinal failure

Answer 20

short gut syndrome 
crohn's disease
neoplasia
vascular 
mechanical 
radiation enteritis 
dysmotility

Question 21

what is short bowel syndrome

Answer 21

unsufficient length of small bowel to meet nutritional needs without artificial nutritional support

Question 22

how is PN given

Answer 22

PICC peripheraly inserted central catheter

Question 23

what are some of the compilations of parenteral nutrition

Answer 23

sepsis 
SVC thrombosis 
line fracture 
line leakage 
line migration 
metabolic bone disease
nutrient toxicity/insufficiency eg.manganese
liver disease

Question 24

what are some indications for oral nutritional supplemements

Answer 24

disease related malnutrition 
intractable malabsorption 
per-operative preparation of malnourished patients
dysphagia 
proven IBD
post total gastrectomy 
SBS
bowel fistulae

Question 25

what are some contra-indications for ETF

Answer 25

``` lower gastrointestinal obstruction prolonged intestinal ileus severe diarrhoea or vomiting high enterocutaneous fistula intestinal ischaemia ```

Question 26

what is re-feeding syndrome

Answer 26

potentially fatal shifts in fluids and electrolytes and distrubances in organ function that may result form rapid initiation of refeeding after a period of under nutrition

Question 27

what is APR

Answer 27

abdominoperineal resection

Question 28

what is the difference in parenteral and enteral feeding

Answer 28

parenteral feeding supplies nutrients directly into the blood enteral feeding-liquid food through a catheter directly into GI tract

Question 29

when would you give enteral feeding

Answer 29

impaired ingestion, inability to intake adequate nutrients orally, impaired digestion, absorption and metabolism

Question 30

when would you give parenteral feeding

Answer 30

short bowel syndrome, sever acute pancreatitis, small bowel ischaemia, intestinal atresia, severe liver failure, bone marrow transplant, acute resp failure

Question 31

what are some contraindications for ETF

Answer 31

``` lower gastrointestinal obstruction prolonged intestinal ileus severe diarrhoea or vomiting high enterocutaneous fistula intestinal ischaemia ```

Question 32

what are some of the metabolic results of re-feeding syndrome

Answer 32

``` hypokalaemia hypophosphataemia hypomagnesia altered glucose metabolism fluid overload ```

Question 33

what are some of the physical consequences of re-feeding syndrome

Answer 33

``` arrhythmias altered level of consciousness seizure resp failure cardiovascular collapse death ```

Question 34

how is re-feeding syndrome linked to insulin

Answer 34

during refeeding insulin is secreted in response to increasing blood sugars which results in increased glycogen, fat and protein synthesis this requires phosphates, magnesium and potassium which are already depleted and the stores rapidly become used up