Small/Large Intestine Flashcards

(31 cards)

1
Q

Specific Feature of Duodenum

A

Brunner’s Glands

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2
Q

Specific Feature of Ileum

A

Peyer’s Patch

M cells

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3
Q

Intussusception

A

telescoping of bowel segment into distal segment
compromised blood supply= abdominal pain with currant jelly stools

Children-idiopathic or infection related
Adult-mass or tumor

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4
Q

volvulus

A

twisting of bowel around its mesentery
-leads to obstruction and infarction
children-midgut
adults-sigmoid

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5
Q

Necrotizing Enterocolitis

A

acute, necrotizing inflammation of small and or large intestine

  • multifactorial
  • terminal ileum or ascending colon
  • edema to necrosis to gangrenous bowel
  • most common acquired GI emergency in PREMATURE or low birth weight neonate
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6
Q

Meckel’s Diverticulum

A

Persistence of omphalomesenteric duct (vitelline duct)

2% of pop
2:1 M
2’’ length
2 ft of ileocecal valve
2 types of ectopic tissue in 1/2 of cases (gastric and pancreatic)
2 major complications (pain with inflammation; hemorrhage with ulcer)

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7
Q

Hirschsprung Disease

A
Congenital Aganglionic Megacolon
Absence of ganglion cells
M:F 4:1
Premature arrest or death of the neural crest cell migration from the cecum to the rectum
1 in 5000 live births 
-Down syndrome (10%)
5% serious neurologic abnormalities
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8
Q

What are signs of malabsorption? What can it lead to?

A

Chronic Diarrhea, steatorrhea, weight loss, abdominal pain, flatus

Pyridoxine, folate, VB12, Anemia
Vit K: bleeding
Ca, Mg, and Vit D: osteopenia and tetany
Vit A and Vit D: peripheral neuropathy

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9
Q

What things can cause pancreatic insufficiency? What does this lead to?

A

Chronic pancreatitis
Cystic Fibrosis
Obstructing cancer

Leads:
Malabsorption of fat and fat soluble vitamins (ADEK)

  • increased neutral fat
  • normal D-xylose absorption test
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10
Q

Disaccharidase Deficiency

A

Most common-lactase deficiency
Osmotic diarrhea
Can occur if injury to tips of intestinal villi (where lactase is located)

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11
Q

Abetalipoproteinemia

A

Decreased synthesis of apolipoprotein B- decreased ability to generate chylomicrons-decreased secretion of cholesterol-fat accumulates in enterocytes
-presents early childhood with failure to thrive

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12
Q

Celiac Disease

A

Digestive and autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten

  • whites
  • .5-1% prevalence

Infants: diarrhea, failure to thrive, abdominal distention, anorexia, weight loss, irritability
Older children: abdominal pain, nausea, vomiting, bloating or constipation
Adults: diarrhea, flatulence, weight loss, and fatigue and anemia
-Dermatitis herpetiformis

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13
Q

How do you make the diagnosis of Celiac disease?

A

Serologic studies:
IgA or IgG antibodies to tissue transglutaminase (TTG)
IgA or IgG antibodies to deaminated gliadin
IgA endomysial antibodies
(sepcific but less sensitive)

(may have IgA def)

Absence of HLA-DQ2 or HLA-DQ8 has high negative predictive value

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14
Q

What does celiac look like on histology and endoscopy?

A

Endoscopy:

  • atrophic mucosa
  • flattened folds

Histology:
Loss of villi
Increased numbers of intraepithelial CD8+ T cell lymphocytes

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15
Q

Tropical Sprue

A

Similar findings to celiac sprue but responds to antibiotics
Cause unknown
seen in residents/recent visitors to tropics

Damage: jejunum (folic acid) and ilium( B12)

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16
Q

In infectious enterocolitis=acute colitis where are the neutrophils?

A

neutrophils in the epithelium and lamina propria

17
Q

Nematode-Ascaris

A

largest intestinal roundworm and is the most common helminth infection of human worldwide

  • eggs are deposited in feces and soil
  • infestation can cause morbidity by compromising nutritional status, affecting cognitive process, inducing tissue reactions such as granuloma to larval stages, and by causing intestinal obstruction, which can be fatal
18
Q

Flatworms

A

Tapeworm: taenia and diphyllobothrium

-ingestion of raw or undercooked fish, meat or pork that contains the encysted larvae

19
Q

Giardia

A

Most common parasite infection in humans

-spread by fecally contaminated food and water

20
Q

Entamoeba Histolytica

A

cyts survive outside the host in water, in soil and on foods

  • release the trophozoite stage in the digestive tract
  • can be asymptomatic or lead to amoebic dysentery or amoebic liver abscess
  • fulminating dysentery, bloody diarrhea, weight loss, fatigue, abdominal pain
  • flask shaped ulcer
21
Q

Pseudomembrane colitis

A
  • most often after antibiotics
  • yellow green false membrane (mixture of mucous and neutrophils)
  • toxin produced by clostridium difficile
  • intractable diarrhea, cramps, dehydration, shock, death

Histology
-mushroom shaped

22
Q

Collagenous colitis

A

Clinical:

  • chronic watery diarrhea
  • 3-20 non-bloody stools per day
  • middle age and older women
  • radiographic studies unremarkable
  • normal endoscopic findings

Histology:
subepithelial collagen

23
Q

Lymphocytic colitis

A

Clinical:

  • chronic watery diarrhea
  • 3-20 non-bloody stools per day
  • affects males and females equally
  • radiographic studies unremarkable
  • endoscopic findings normal
  • strong association with autoimmune disease

Histology:
intraepithelial lymphocytes
NO epidermal collagen-Trichrome negative!

24
Q

Whipple Disease

A

Rare
Gram positive rod shaped actinomycete: tropheryma whipplei
-engulfed by macrophages(PAS positive diastase resistant)
More common in men
Malabsorption, lymphadenopathy, and arthritis

Histology:
Lamina propria distended with foamy macrophages
PAS positive organisms

25
Inflammatory Bowel Disease
Increasing in incidence-hygiene hypothesis Genetics-increased risk in family Mucosal immune response-immune suppression is treatment Epithelial defects-defects in tight junctions maybe paneth cell issues Microbiota-change in the bacterial flora especially in the mucous
26
Crohn's Disease Clinical
Teen/twenties and fifties/sixties Caucasians> non Caucasian Jewish>non Jewish Disordered response to bacteria Diarrhea, crampy abdominal pain: RLQ, low grade fever -increased incidence of cancer in SI and colon Symptoms: Usually begins with intermittent attacks of mild diarrhea, fever, abdominal pain Asymptomatic periods Recurrent attacks or flare ups of diarrhea -can present abruptly with RLQ pain Complications: fibrosing strictures, fistulas, gallstones, malabsorption, CRC Extraintestinal: -migrating polyarthritis, kidney stones
27
What is the gross anatomy in Crohn's disease
- May occur at any point along the GI tract - Usually affects terminal ileum, ileocecal valve, cecum - mucosa show linear ulceration and fissure formation - segmental involvment sparing other areas - serosal creeping fat - cobblestoning - fistula with bladder
28
Crohn's disease histology
- Transmural inflammation - cryptitis-crypt abscesses - ulceration - non caseating granulomas
29
Ulcerative Colitis Clinical
Autoimmune Symptoms: -relapsing attacks of BLOODY mucoid diarrhea with pain -recurs after asymptomatic interval -may have an explosive initial attack with serious bleeding to constitute a medical emergency Complications: primary sclerosing cholangitis, CRC, toxic megacolon, malnutrition Extraintinal: primary sclerosing cholangitis
30
What is the gross anatomy of ulcerative colitis?
Inflammation primarily involving the mucosa of the colon - diffuse continuous inflammation that begins in the rectum and progresses proximally - pseudopolyps - loss haustra
31
Ulcerative colitis histology
Early Phase: neutrophils and crypt abscesses Later phase: mucosal ulcerates and pseudopolyps form Late Phase: atrophy and possible dysplasia -increased risk of colon carcinoma - NO granulomas - ONLY in mucosa/submucosa not transmural