Small Intestine and colon Part 1 Flashcards Preview

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Flashcards in Small Intestine and colon Part 1 Deck (48):
1

What causes the obstruction os the small intestine

80% are Lesions hernias, intestinal adhesion, intussusception and volvulus

10 to 15% are tumors, infraction and other causes of strictures, Crohn Disease

2

What are the manifestations of Intestinal Obstruction

Abdominal Pain and discomfort and vomiting and constipations

3

What is the mechanism of Intestinal Obstruction

Normal flow of intestinal contents is disrupted - proximal dilation + distal decompression

4

What are the complication of Intestinal obstructions

Bowel ischemia due to bloody supply being strangulated, inflammation leads to venous congestion, edema and distortion or normal bowel absorptive function - increased intraluminal fluid. Transudative fluid loss ( hypovolemia into peritoneal cavity, electrolyte disturbance
Shock
Perforation

5

What is the presentation of Small bowel Obstruction

Nausea and vomiting early
Abdominal pain that comes and goes
distension occurs
constipation occurs
Bowel sounds increased
in X-ray the is an increase in air fluid levels

6

What is the presentation in Large Bowel Obstruction

Nausea and vomiting late
Abdominal pain that comes and goes
distension occurs
constipation occurs
Bowel sounds increased
in X-ray the is an increase in air fluid levels

7

What is the prestantion of Pseudo-Obstruction

Nausea and vomiting occurs
Abdominal pain is minimal
distension occurs
constipation occurs
Bowel sounds decrease
in X-ray the is an increase in air

8

What are the causes of small bowel obstruction

S - stricture
H - hernia - 2nd cause
A- adhesion - MCC
V -volvulus
I - intussception
N - Neoplasm 3rd cause
G - Gallstones

9

What are the causes of large bowel obstruction

Cancer
Diverticulitis
Volvulus

10

What is adhesions

Fibrous Band that forms between tissues Natural part the body’s healing process after surgery, similar to how a scar forms. Adhesion extend from within one tissue across to another, usually across a virtual space such as the peritoneal cavity. adhesion formation post surgery typically occurs when 2 injured surfaces are close to one another. this often cause inflammation and cause fibrin deposition onto the damage tissues.

11

What is a hernia

Defect in fascia - protrusion of bowel into sac. Males are more likely than females. Most common is the indirect (50%).

12

What is the Progression of the Hernia?

Entrapment, Incarceration, Strangulation ( Blood supply to the part of the bowel is blocked) and Infarction

13

What are the risk factors of hernia

Chronic Cough
Pregnancy
Constipation
Obesity
Ascites
Straining
Hernia repair
Heavy lifting

14

What are the features of Hernia

Bulging with the patients coughs, sits ups and goes away when the patient is upon or when reduces
REMEMBER MD's don't lie

15

What is Volvulus? What is the most common area

Rotation of a segment of bowel about its mesenteric axis.
Sigmoid Colon due to the shape

16

What is intussusception

Part of bowel folds into another section of bowel ( telescoping) Mostly seen in the Kids: M>F

17

What are the complications of Intussusception

Obstruction, infarction and necrosis

18

What are the clues of intussusception

Sausage shaped Palpable mass

Rectal Bleeding

Kids Crises and draws knees up to chest

DONUT!!!!! or Target sign!!!

19

What is a major of Intussusception

There may be HSP or Henoch-Scholein Purpura. This is mainly in kids that follows an upper respiratory infection. there may be vasculitis, purport on buttock and legs, along with abdominal pain and Arthritis.

20

What is colonic Pseudo-Obstruction and what are the types

Symptoms similar to intestinal blockage but no physical signs of blockage.

Paralytic ileus and Ogilvie's syndrome

21

What is paralytic ileus?

Temporary paralysis of myeneteic plexus. tends to occur in postoperative surgeries and medications

22

What is ogilivie syndrome

Acute pseudo obstruction. tends to happen in bedridden patients that have a serious extra intestinal illness like trauma, infection and cardiac

23

What is ischemic bowel disease

is a medical condition in which injury of the small intestine occurs due to not enough blood happens in the splenic flexure or the watershed region

24

What are the causes of ischemic bowel disease

Clots
Atrial Fibrillations
DVT
Cardiac Vegetation
Malignancy

Low Perfusion/ Hemorrhage
CHF
Shock
Dehydration
Vasoconstriction drugs

25

What are the signs of Ischemic Bowel Disease

Sudden severe left sided abdominal pain and bloody stools

26

What is Necrotizing Enterocolitis

blood vessels have not completely developed. leads to bowel necrosis. That happens in premature infants

27

What is the sign and symptoms Necrotizing Enterocolitis

Poor feeding
Abdominal distension
Bloody stools

28

What is angiodysplasia

Vascular malformation of the gut that is present in older patients. the MCL is the cecum and ascending colon. It is the 2nd MCC of lower GI bleeding.

29

What is the MCC of Angiodysplasia

DIVERTICULOSIS

30

What is the associated angiodysplasia

aortic stenosis. vWF gets damaged due to high stress at the aortic valve and it leads to bleeding

31

What are hemorrhoids

Dilated anal and perianal collateral vessels that connect the portal and naval venous system to relieve elevated venous pressure with the hemorrhoid plexus.

32

What risk factors hemorrhoids

Constipation and straining, pregnancy, portal hypertension, obesity and heavy lifts

33

What steatorrhea and what are the signs

it is frothy, foul smelling stool.
signs :
Bloating
Cramps
Diarrhea
Flatulence
weigh loss

34

What are the causes of Steatorrhea

CF
Celiac disease
Crohn disease

35

What is Meconium ileus

the inability to pass the first feces meconium. is a sign of cystic fibrosis

36

What is a differential diagnosis of meconium ileus

Hirschsprung disease

37

What is Hirschsprung disease

it is the failure of neural crest cells to migrate and pass the meconium

38

What is a good clue for Meconium ileus

CLUE: child comes in with a history of multiple respiratory infection - CF

39

What is celiac disease

Celiac sprue or gluten sensitive enteropathy. immune mediate enteropathy triggered by the ingestion of gluten-containgn cereals ( wheat, rye or barley) in genetical predisposed people.

40

What are the stats on Celiac disease

Caucasian
associated with outer autoimmune disease
HLD-DQ2 and 8
Females more than males

41

What is the pathogenesis of Celiac disease

Gluten digested by luminal & brush order enzymes into amino acid Gliadin
Gliadin is De-aminated by tissue transglutaminase (tTG)
It then interacts with HLA-DQ2 or HLA-DQ8
Cytokines and ***anti-tissue transglutaminase***, anti- gliadin & anti-endomysial antibodies produced
CD8+ cells produce IL-15 that triggers intra-epithelial lymphocytes
These lymphocytes become toxic and damage the epithelium

42

What are the manifestation of celiac disease

Bloating
cramps
diarrhea
gas
weigh loss
fatigue
Bone - osteoporosis
CNS - depression
Skin - dermatitis Herpriormis

43

What is a complication of celiac disease

Cancer - t-ccell lymphoma

44

What is whipple disease

infection that is caused by trophermy Whippelli

45

What is the pathogenesis of whipple disease

PAS-positive macrophages in lamina propria
Block lymphatics & reabsorption of chylomicrons

46

What are the manifestation of Whipple disease

Fever
Steatorrhea
Polyarthritis
Lymphadenopathy
Increase skin pigmentation

47

What is lactose deficiency

Lactase are located in the apical brush border membrane of the villous absorptive epithelial cells

48

What are the types lactose deficiency

Rare; Autosomal recessive

Acquired
Native Americans, African Americans, Chinese

Clues to diagnosis – symptoms resolve after stopping milk & milk products