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
