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Clin Med I- GI > Small Bowel > Flashcards

Small Bowel Flashcards

1
Q

How does small bowel get its blood supply

A

From superior mesenteric artery

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2
Q

Drainage of small bowel

A

superior mesenteric vein, which drains into portal vein, into liver

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3
Q

Lymph drainage of small intestine

A

Goes through regional lymphatics to the cisterna chyli

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4
Q

Small intestine innervation

A

Parasympathetic nerves from right vagus, sympathetic nerves from greater and lesser splanchnics (visceral pain)

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5
Q

Layers of small intestine from lumen outwards

A

Mucosa, submucosa, muscularis, serosa

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6
Q

What does mucosa layer of small intestine contain

A

plicae circulares, villi, microvilli, crypts of lieberkuhn

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7
Q

which layer of small intestine contains the nerves and blood vessels? Is also the strongest layer

A

submucosa

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8
Q

Muscularis layer of small intestine contains…

A

both longitudinal and circular muscles

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9
Q

As you go from jejunum to ileum, what changes occur?

A

vascular arcades become more complex, lumen narrows, and circular mucosal folds become shorter and fewer

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10
Q

IBD major divisions

A

Crohn’s dz and ulcerative colitis

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11
Q

What are independent risk factors for crohn’s disease

A

smoking and high sugar

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12
Q

Which site is most frequently affected in Crohn’s disease

A

terminal ileum

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13
Q

Skip lesions seen in Crohn’s or UC?

A

Unique to Crohn’s

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14
Q

Creeping fat sign unique to…

A

Crohn’s disease

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15
Q

Patient presents wtih diarrhea, recurrent acute abdominal pain, anorectal lesions, anemia, malnutrition. Abdomen pain releived by defecation. Thickened bowel wall, stricture formation, “creeping fat,” in mucosa- pinpoint hemorrhages, cobblestoning, aphthous ulcers. Malaise, weight loss, fever. Systemic manifestations include pyoderma gangrenosum, uveitis, bone and joint lesions, pericarditis, Dx?

A

Chrohn’s

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16
Q

Signs and symptoms in Crohn’s

A

MACARDS- malnutrition, anemia, constitutional symptoms, anorectal lesions, recurrent and acute abdominal pain, diarrhea, and systemic manifestations

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17
Q

diarrhea in Crohn’s

A

continuous or intermittent. If non-bloody, SB involved. If bloody, think colon.

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18
Q

abdominal pain in crohn’s

A

chronic pain- mild, following meals, in low mid abdomen, relieved by defecation. acute pain- RLQ- TI involved usually

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19
Q

Acute RLQ pain in crohn’s mimics..

A

appendicitis

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20
Q

constitutional effects in crohn’s

A

lassitude, malaise, weight loss, fever

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21
Q

anorectal lesions in crohn’s

A

chronic anal fissures, large ulcers, edematous skin tags, complex fistulas, and recurrent peri-rectal abscesses

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22
Q

anemia in crohn’s

A

iron deficiency anemia, macrocytic anemia, vitamin B12 or folate deficiency. May see angular cheilitis

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23
Q

signs of malnutrition in crohn’s

A

steatorrhea, chronic partial obstruction, decreased oral intake (hurts when eating), vitamin D and zinc deficiency common, protein-losing enteropathy, growth retardation in children

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24
Q

Labs in Crohn’s

A

Prometheus test for IBD. tests for antibodies include ASCA, I2, ompC, CBir1 which will be elevated in Crohn’s. pANCA higher in UC

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25
Q

Xray signs of Crohn’s

A

String sign- stricture through segment of small bowel. and cecal narrowing

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26
Q

Medical tx in crohn’s

A

aminosalicylates, anti-TNF alpha, antibiotics, immunosuppressives, steroids

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27
Q

Key guideline when performing surgery in crohn’s

A

preserve intestinal length- only take out what is absolutely necessary. If take too much out, patient will be on TPN (total parenteral nutrition) forever

28
Q

Crohn’s has no surgical or medical cure. T or F?

A

TRUE!

29
Q

Acute form of colonic distension in which colon dilates and perforates

A

Toxic megacolon

30
Q

What other anatomical part of GI tract is also involved in UC besides colon?

A

Rectum usually involved

31
Q

Backwash ileitis may be observed in…

A

UC

32
Q

Diagnosis of UC by

A

Endoscopy- loss of vascular pattern, granularity, friability, hyperemia, ulceration. no patches of normal mucosa. Barium enema can help diagnose- “lead pipe” - loss of haustral markings, pseudopolyps, fine serrations

33
Q

apple core lesion -

A

stricturing in UC should raise suspicion of cancer

34
Q

Truelove and Witt classification

A

classifies UC severity

35
Q

How many stools per day are mild, severe, vs. fulminant

A

Less than 4 stools/day= mild UC. More than 6/day, severe diarrhea. More than 10 day, fulminant diarrhea

36
Q

Medical tx of UC

A

Avoid NSAIDS, lactose. Sulfasalazine, steroids.

37
Q

Indications for Surgical tx of UC

A

acute severe disease that doesn’t respond to medical tx, emergently in perforation, urgently in toxic megacolon, hemorrhage, refractory fulminant colitis

38
Q

What are Ladd’s bands

A

Congenital bands often discovered during infancy. Occur with malrotation causing obstruction of small bowel

39
Q

Most common surgical disorder of the small intestine due to

A

obstruction

40
Q

Mechanical obstruction of small bowel

A

Simple obstruction, strangulation, and closed loop obstruction

41
Q

Causes of small bowel obstruction

A

A New FIV Hurray Voila!- volvulus, cystic fibrosis, adhesions, neoplasm, stricture, foreign bodies, Gallstone ileus, Hernia, hematoma, IBD, intussusception

42
Q

Most common cause of small bowel obstruction

A

adhesion- caused by inflammation of the abdomen or by surgery

43
Q

“Target sign” on CT indicative of

A

intussusception in adults

44
Q

intussusception more common in which population

A

children.

45
Q

Tx of intussusception in children

A

Barium enema- diagnostic and tx

46
Q

Most common site of foreign body small bowel obstruction is…

A

ileocecal valve

47
Q

Patient presents with vomiting, abdominal pain, and obstipation. She has high pitched bowel sounds, peristaltic rushes, gurgles, tympanitic percussion, and distension. Tachycardia, dehydration. Xray shows air fluid levels and stair stepping. Amylase elevated, hemoconcentration, electrolyte abnormalities, leukocytosis. Dx?

A

smal bowel obstruction

48
Q

proximal vs. distal SBO differences in vomiting, obstipation, and abdominal pain

A

vomiting in Proximal SBO occurs early and is profuse, obstipation late. distal SBO- vomiting late and feculent, obstipation early

49
Q

SBO tx

A

NGT, IVF, NPO, pain control. complete SBO- surgery. partial SBO- bowel rest.

50
Q

Patient presents with severe continous pain, hematamesis, peritoneal signs on exam, leukocytosis, lactic acidosis. Bowel blocked in 2 places. Dx

A

Closed loop obstruction

51
Q

Patient with sudden severe diffuse abdominal pain but physical exam is normal. CT also negative. could be..

A

acute mesenteric ischemia

52
Q

Gastroenteritis tx

A

Viral- so NO ABX. stool studies, hydration, replace electrolytes, avoid anti-diarrheal medication

53
Q

Most common small bowel benign tumors

A

adenomas

54
Q

Most often found benign small bowel tumors (most symptomatic)

A

GIST (like leiomyomas and leiomyosarcomas)

55
Q

Most common primary malignant small bowel tumor

A

adenocarcinoma

56
Q

What predisposes someone to primary SB lymphoma in proximal jejunum?

A

celiac disease

57
Q

Small bowel malignant neoplasms

A

primary malignant tumors, metastatic malignant tumors, and carcinoid tumors

58
Q

carcinoid small bowel neoplasms arise from… and associated wtih….

A

arise from enterochromafin cells. associated with MEN type 1 and 2

59
Q

what is most common site in carcinoid small bowel neoplasms

A

appendix

60
Q

10% of patients with carcinoid tumor have “carcinoid synrdrome” which includes

A

bronchoconstriction, diarrhea, flushing, and R sided heart valve disease from collagen deposition

61
Q

Which carcinoid tumors would you more likely see carcinoid syndrome in?

A

Ovarian, bronchail carcinoids, and hepatic metastases more than intestinal carcinoids- circulation related

62
Q

How to test for lactose intolerance

A

Lactose breath test OR give 100g oral lactose, check blood glucose every 30 min x 2 hours to see if it rises more than 20mg/dl over that time

63
Q

Tx of lactose intolerance

A

lactose free diet, supplementation of vitamin D, calcium, and riboflavin

64
Q

tx for celiac disease

A

gluten free diet

65
Q

diagnosis of celiac disease

A

igA endomysial antibodies, igA tTG antibodies

66
Q

What part of GI tract does celiac disease damage?

A

Diffuse damage to proximal SB

Clin Med I- GI (10 decks)

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