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Flashcards in Small Intestinal pathology Deck (51):
1

Intestinal failure =

inability to maintain adequate nutrition/fluid status via the intestines

2

Acute intestinal failure lasts up to ___
Type 1 =
Type 2 =

2 wks
1= self limiting postop/paralytic ileus => HDU/ITU
2= prolonged and ass. with sepsis and other metabolic complications

3

Chronic/type 3 cause of intestinal failure =

short gut syndrome

4

Type 3(chronic) intestinal failure treatment =
UNLESS ___

home parenteral nutrition UNLESS they have cancer too
OR intestinal transplant

5

Type 1(acute) intestinal failure treatment

replace fluids and electrolytes
PPI and octreotide - decrease acid
α-hydroxycholecalciferol - preserves Mg

6

Type 2 (acute) intestinal failure treatment

parenteral by PICC or tunneled catheter/vascuport

7

Complications of parenteral nutrition

sepsis
SVC thrombus
line fracture/leak/migration
metabolic bone disease
nutrient toxicity/insufficiency
liver disease
metabolic disturbances

8

Short bowel =

less than 200cm of small intestine
inadequate for nutritional needs
diarrhoea and frequent defaecation

9

If have ___ of small bowel then need HPN

less than 50cm

10

Main indications for intestinal transplant = __+__

loss of venous access/liver disease

11

Ischaemia of the small bowel can be caused by

mesenteric artery occlusion
non-occlusion perfusion insufficiency eg. shock/strangulation
hyperviscosity
drugs eg. cocaine = spasms

12

___ layer of gut wall is most affected by small bowel ischaemia as it is ___

mucosal
most metabolically active

13

Progression of ischaemic small bowel with time:

mucosal infarct (can regen)
mural infarct (regen = fibrous stricture)
transmural infarct (gangrene => death if not removed)

14

in non-occlusion causes of ischaemic small bowel the damage occurs __

after reperfusion

15

Meckel's diverticulum =

incomplete regression of villeo-intestinal duct 2 ft from IC valve in small intestine

16

Meckel's diverticulum may contain ___ which secretes __
bleeding/perforation/diverticulitis may occur and mimics ___

gastric mucosa => acid
appendicitis

17

Primary tumours of the small bowel are rare/common
= (3)

lymphoma
carcinoid
carcinoma

18

Treat lymphomas of the small bowel with ___
They are ___ which are __/__ derived

surgery and chemo
non-Hodgkin's
Maltoma - B cell
enteropathy ass T cell lymphomas - ass. w. coeliacs = high grade and aggressive

19

Carcinoid tumours in the small bowel are commonest in the ___
Look:
most commonly spreads to __

appendix
small, yellow and slow growing. Locally invasive, may cause intusussception/obstruction
liver

20

Carcinoma of the small bowel is ass with _+_
identical to ___ in appearance
Present early/late
metastasis to _+_

coeliac's and Crohn's
colorectal carcinoma
late
liver and lymph nodes

21

2ndry cancer of small bowel primary sources =

ovary
colon
stomach

22

causes of appendicitis =

unknown
faecoliths due to dehydration
lymphoid hyperplasia
parasites
tumours (rare)

23

Pathology of appendicitis :
__ inflam w. neutrophils wwhih must involve the ___> mucosal ___ > serosal ___(exudate) > __ in lumen

acute involing the muscle coat
ulceration
congestion
pus

24

Coeliac's =

AI
Abnormal T cell reaction to gliadin in gluten => villi atrophy and decreased absorptive capacity

25

Coeliac's is strongly associated with ___ serotype

HLA -B8

26

Strongly associated with dermatitis herpetiformis, TID and hypothyroidism =

Coeliac's

27

T cell response to gliadin in coeliacs causes:

villi atrophy, flat duodenal mucosa
inflammation of the lamina propria

28

Auto-antibodies present in Coeliac's

anti-TTG
ati-endomesial, anti-gliadin

29

Investigations to diagnose Coeliac's

endoscopy
duodenal biopsy
serology for autoIgs

30

Effects of coeliac's:
1) ____ (of fat =>___)
2) ___ intestinal hormone production => ___ pancreatic secretion and bile flow(CCK) = ___

malabsorption => steatorrhoea
decreased decreased =>gallstones

31

Signs of coeliac's

wt loss
anaemia
abdo bloating
FtT
vitamin deficiencies

32

T cell lymphomas of GI tract are associated with

coeliacs

33

In coelics:
gliadin binds to ___ on int. wall which activates ___
> ___ > mucosal lesion

HLA-DQ2/8
T cells
cytokines

34

Diagnosis of lactose intolerance is by

lactose breath H+ test
OR
oral lactose intolerance test

35

Lactose intolerance =

lack of lactase

36

Tropical sprue =

colonisation of intestines by infectious agent/alteration in normal flora

37

treatment of tropical sprue=

tetracycline and folic acid

38

Whipple's disease =

rare, systemic infection by gram +ve Tropheryma Whipplei causes increase in the frequency of HLA B27

39

Signs of Whipple's disease =

arthritis, diarr+steatorrhoea, wt. loss, fever, abdo distension

40

Small bowel bacterial overgrowth of __/__ causes ___ anaemia (lack of __)
most common if __/__/__ present in gut

e. coli/bacteroides
macrocytic B12
diverticulae/fistulae/strictures

41

Diagnosis off small bowel bacterial overgrowth is by:

low cobalamin (B12) and high folate levels
Schilling test: give B12+folate and see if absorb
jejunal aspirate and culture

42

Treatment of small bowel bacterial overgrowth

surgical correction of anatomical blind loop
tetracyclines 2-3wks

43

Dermatitis herpetiformis =
due to ___

itchy blisters on extensor surfaces
sub-endothelial IgA deposition

44

borborygmi =

gurgling due to gas or fluid in small intestine

45

Investigations for small bowel obstruction

urinalysis
ABG
bloods
AXR
contrast CT
gastrograffin imaging

46

Treatment for adhesional causes of small bowel obstruction

drip and suck (analgesia + fluid + K+ + catheterise + NG tube)
anti-thrombotic measures
for up to 72 hrs

47

Small intestine/colon has less collaterals and is more prone to necrosis if becomes ischaemic

small intestine

48

Signs of mesenteric ischaemia of the small intestine

pain, acidosis
increased lactate
small raise in WCC
CT angiogram and laparotomy results

49

Treatment of mesenteric ischaemia of small intestine:

quick
if non-viable = resect
viable = embolectomy

50

Remnant of omphalomesenteric duct

Meckel's diverticulum

51

haematochezia =

passage of fresh blood PR