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Flashcards in Small Bowel and Appendix Deck (43)
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1

Tumors of the appendix

About 1/2= carcinoid (neuroendocrine tumor), mets to liver can produce serotonin syndrome (episodic flushing, diarrhea, wheezing and right sided valvular heart disease)
-Mets rare if tumor pseudomyxoma peritonei charac by diffuse collections of gelatinous material thru the abdomen

2

Appendicitis

-mid abdominal pain that migrates to the RLQ
-Nausea and vomiting -High fever, WBC count and severe pain suggest perforation.
-IV fluids, IV antibiotics and surgical resection are the treatment.

3

Plicae circulares

more in prox jejunum, absent terminal ileum

(ileum empties into cecum of LI)

4

absorption and transport of fluids

9L secreted/ingested
8.9 L absorbed
100 ml excreted

5

Malabsorption/maldigestion

-inadequate absorp of nutrients
-Clinical signs: weight loss, diarrhea, steatorrhea, vitamin deficiencies
-Pale, bulky, malodorous stool: float, hard to flush, oily residue

6

Causes of malabsorption

Surgery:
-gastric bypass
-small bowel resection
Bacterial overgrowth
Meds:
cholestyramine-ADEK
phenytoin, folate
Pancreatic insufficiency
Liver disease
Intestinal inflammation/villous flattening (celiac sprue, Whipple's disease, tropical sprue)
Ulceration
Ischemia
Infiltration (amyloidosis)

7

What test might you use to dx fat malabsorption?

Sudan fat stain

8

Pancreatic insufficiency

90% burned out
Lipid (first) then protein then rarely carb malabsorption
-chronic pancreatitis
-CF

9

Liver disease

bile needed for absorption of lipids
-Cirrhosis (decreased func of hepatocytes, decreased bile formation)
-Biliary obstruction

10

Gastric Bypass

B-II, Roux-en Y

inadequate mixing of food with biliary and pancreatic secretions

11

Gastric Bypass Vitamin Deficiencies

B12, Fe, Ca, Vit D deficiencies are the most common
-Vit C, Cu rare
Prevention: multivitamin
Monitoring recommended

12

Small Bowel Bacterial Overgrowth

Normal:

13

Vitamin levels with bacterial overgrowth and
Dx

fat soluble vitamins and B12 deficiency (bacteria deconjugate bile salts, bacteria consume B12)

Folate: normal to high (bacterial production)

Dx:
-Aspiration of duodenum w/ culture
-Glucose-hydrogen breath test
-empiric treatment with antibiotics
Treatment: antibiotics (eg Ciprofloxacin)

14

Sx of Vit A def

night blindness
xerophthalmia

15

Sx of Vit D def

Osteomalacia
-bone mineralization defects

16

Sx of Vit E def

rare in adults
hemolytic anemia

17

sx of vit K def

clotting dysfunction
-PT

18

Celiac Sprue

-gluten sensitive enteropathy (wheat, barley, rye)
-inflammatory disease of small intestine
-loss of villi, crypt hyperplasia, lymphocytes
-80% asx (0.5-1% of US pop)
-incidence increases with age

19

Signs/sx of celiac sprue

Abdominal distension
Abdominal pain
Anorexia
Bulky, sticky, pale stools
-Steatorrhea
Diarrhea
Flatulence
Failure to thrive
-Weight loss
-Fatigue
Vomiting

20

Atypical signs/sx of celiac sprue

Iron deficiency Anemia
Dermatitis Herpetiformis
Liver function tests
-AST, ALT elevations
Cerebellar ataxia
Osteoporosis
Oral apthous ulcers

21

Celiac pathogenesis

-assoc w/ autoimmune diseases: thyroiditis, Type-I DM
-HLA-DQ2, HLA-DQ8 (40% US)
APC MHC II present gluten peptides

CD4+ Tcell response
All have ab to tissue transglutaminase (TTG)

22

Dx of Celiac sprue

Dx:
-finding on SI biopsy
-Serologic tests: anti-TTG, anti-endomysial antibodies, anti-gliadin IgA and IgG

Tx: gluten free diet

23

Findings on endoscopy for celiac

scalloped duodenal folds

24

Tropical sprue

-residents/visitors of tropics
-Cause: bacterial toxins or colonization of aerobic coliform bacteria

Classic presentation: Megaloblastic anemia from B12 and folate deficiency

Diagnosis: intestinal biopsy with villous flattening and travel history

Treatment: Antibiotics, B12, and folate

25

Whipple's Disease

RARE (

26

Mesenteric Ischemia

Atherosclerosis, Clot, Radiation

Chronic: 2 of 3 major vessels occluded
post-prandial abdominal pain, weight loss, sitophobia, malabsorption

Acute: embolus, severe abdominal pain

27

Malabsorption diagnostic tests

Focused testing-clinical scenario
Fecal Fat
Vitamin levels
CBC, albumin
CT-small bowel, liver, pancreas, bile ducts
Endoscopy

28

Small Intestinal Tumors

RARE primary tumors (

29

Two main causes of diarrhea

decreased fluid/elec absorption
increased secretion

-occurs when colonic water load exceeds absorptive capacity

30

Diarrhea classification

Fatty
-malabsorption
-maldigestion

Watery
-osmotic
-secretory

Inflammatory/exudative

Functional