W5: intestine Flashcards by Unknown Unknown

infectinous coligits(acute self limited): pathogens causing it

campylobacter jejuni
salmonella, shigella species,ecoli, yersinia enterocolitica

CONTAMINATED FOOD:e: Travellers Diarrhea, ETEC, EPEC, EHEC, EIEC etc. NORO

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pathophysiological mechanism of infectious colitis

microorganism incae mucosa/produce enterotoxins..>epi injury and acute infla reaction–>eneterotocin–>alter transport of electrolytes and water

The ability of microorganisms to infiltrate the intestinal mucosa or produce enterotoxins

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infectious colitis: clinically

abdomainal pain, diarrhea-bloody, fever

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pseudomembranous colitis: pathogene

C.difficele
-antibiotic adminiastaion
-destruction of normal flora

TOXIC MEGACOLON

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Indlammatory bowel disease include

crohn disease + ulcerative colitis

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crohn disease
affect
key feature
micro
complicaiton

affect:TERMINAL ILEUM
-distal small and procimal large intesitne

key feature
-transmural
-discontinous

mciro:
-presence of non casefying infla granulomas
- affected part is thick. rigid liek a hose
- spreding ulcers in mucosa, mucosa btw them is swollen like cubes
-ulcer–>deeper linear(fissure)
-mesenteric LN enlathed

complication
-fistula and strictures
-fibrostenosisng

Also risk for adenocarcinoma but less than ulcerative

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extrintestinal manifestation of chrons

athropathy, arthralhaos
mucocutaneos lesions: pyoderma, gangresoum, erythema nodosum
episclerative and uveits
cholelithiasis

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ulcerative colitis
charcateristic clinical
key fetaure
micro

charcteristic:
-bloody diarrhea

key:
-limited to mucosa
-continous: RECTUM and extending proximally

mcir:
-normal thickness
-mucosa flattened, bloody
- diffuse lymphoplasmocytic infiltarte in lamina propina
-paneth cell metaplasia in left colon
-EROSINONS AND ULCERS:Intact mucosa between ulcers has the shape of “inflammatory pseudopolyps” !!!!!!!!!!!!!

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Ulcerative colitis
-complications
- clinical
extrintestinal manifiestetion

complictions:
-toxic megacolon
-perfroation with peritonits
-adenomcarcinoma,
-pseudopolyos
-hemorrhage

clinically:
-procotos
-extensive colitis diarrhea, rectal bleeding abd pain, fever, weight loss
-fulminant colitis

etraintesinal ,amnif
-athropathy
-pri scelorising cholangitis -PSC
- episcleritis and uveitis
-mucocutanous lesion: erythrema nodosum, pyoderma

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polyp defintiaiotn

localised projection above the surrounding colonic mucosa

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Hamartomatous polyps

juvenile
polyposis syndrome, Peutz-Jeghers, PTEN hamartoma tumour syndrome)

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peutx jeghers syndorme

AD
charcterized by mucocutanous pigmentaiton, hamartomatir poplups

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most common polyp in colon

hyeperplastic:
-non dysplastic epi prolif
-asympt
-left colon and rectum

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sessile serrated lesions/adenoma

Epithelial neoplasms with distinctive serrated epithelial architecture and associated risk for colorectal cancer
(serrated pathway of carcinogenesis)
o Precursor lesions for the carcinomas

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traditional serrated adenomas

Serrated neoplastic precursor lesion for aggressive BRAF mutated microsatellite stable (MSS) subtype of colorectal
carcinoma

-ectopic prominent eosinophilic cytoplasm,ectopic crypts

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conventional adenoma of colon

potential
classidication
where
clinically

the potential for transformation to invasive
carcinoma
* Types of conventional adenoma:
o Classified by architecture into
▪ Tubular
* Numerous tubular structures lined by dysplastic epithelium
▪ Villous
* Usually without stalk. Sessile. Micro: villous structures lined by dysplastic epithelium
▪ Tubulovillous
their epithelium is by definition dysplastic

More common in the left hemicolon, but can involve any part of the large intestine

clinical: asymptomatoc, overt/occult rectal bleeding

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msot of colonic cancers are

adenocarcinoma
most are in sigmoid colon and rectum

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lynch sundrome

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-AD
- younger age
-DNA MMR gene
- proximal colon
-incresed endometriu, ovary, stomach ,SI, UTM oancreas, hepatobiliary tract, skin, CNS

most commoon cause of inherited colorectal caner

familai adenomatous polyps-FAP

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less than 1% of colorectal
-rectal bleeding, colicky abd pain diarrhea
-<5mm polyps

appencdicitis most common cause

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obstruction in 50-80% du to FECALITH

also gallstone, tumor, enterobius vermicularis(worm), diffue lymphoid hyperplasia

children+elderlt over 60

pathophysio of acute appendicitis

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pbstruction causes ^ontraluminal pressure, collapse of draining veins, ischemia, mucosal injury and ulceration

acute appendicitiso: clinicall and complicaiton

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clinical:
- periumbilical to right lower quadrant pain
-nausea, vomiting
-abd tenderness
-mild fever

complicaiton
-wall abcess and perforation–>PERITONINTS
-phylephlebitis-inflammed thombosis of portal venous drainage

granulomatous appendicitis cause

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-idiopathic

peritonitis

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Peritonitis = inflammation of the peritoneum
* 2 form: bacterial and non-bacterial peritonitits

bacterial peritonits: causes

Causes: 1. Perforation of an abdominal organ e.g., ▪ Appendix ▪ diverticula ▪ severe ischaemia may lead to perforation ▪ tumours with ulcerative growth pattern which can perforate to the serosa surface 2. Peritoneal dialysis ▪ due to contamination of instruments or dialysate !!!!!enteric organisms move from gut to the mesenteric lymph node and seed the ascitic fluid!!!!!!!!!!!!!

bacterial peritonitis: clinically

* Clinically: o Acute abdomen, distention, severe abdominal pain and tenderness, nausea, vomiting, high fever o Generalized peritonitis -> paralytic ILEUS and SEPTIC SHOCK * Fibrinopurulent exudate covers the surface of the intestine -> fibrous adhesions between loops of bowel -> obstruction of lumen (ileus) * Such adhesions may lead to volvulus and intestinal obstruction

Non bacetrial/chemcial peritonitis cause

perforated GALLBLADDER, perforated pepti ulcer acute pancreatitis foreign material in surgery leakage of urine-pelivc trauma blodo-endometriosis, abd trauma

A serious complication of acute peritonitis is

Generalized peritonitis and septic shock

A complication of overcome (suffered) peritonitis is:

Intestinal adhesion and ileus

Transverse (??) bacterial peritonitis may be:

Cirrhous complication by portal hypertension and ascites

ileus

disruption of the normal peristalsis of the GIT (failure of peristalsis) (=no movement in the GIT) * Divided into mechanical obstruction and dynamic ileus

obturation ileus

-Due to intraluminal obstruction (e.g., by gallstone, foreign body, tumour) -external compression of lumen (e.g., by adhesions, tumour), or inside the wall (M. Crohn, strictures, tumour (esp. signet ring cell carcinoma))

strangulation ileus

Intraluminal occlusion + compression of mesenteric (volvulus, intussusception, hernia incarceration)

spastic ileus

Spasm of muscle (e.g., due to porphyria, poisoning, ...)

paralytic ileus

Muscular and neurological disorders (e.g., by myasthenia, cerebrovascular accidents, ALS)

upper gi bleeding

Oesophageal varices * Associated with liver cirrhosis and portal hypertension ▪ Mallory-Weiss tear * Occurs after extensive coughing or vomiting ▪ Haemorrhagic gastritis ▪ Gastric ulcer * Mainly peptic ulcers but also caused by tumours * Mostly caused by Helicobacter pylori infection and NSAIDs ▪ Duodenal ulcer

SI bleeding

Ischaemic bowel disease * May be due to obstruction of the main artery ▪ Intussusception ▪ Meckel diverticulum

lower intestinal bleeding

Anal fissure & Haemorrhoids * Most common cause of LI bleeding ▪ Inflammatory bowel disease * Ulcerative colitis ▪ Diverticulosis ▪ Colonic carcinoma ▪ Rectosigmoid carcinoma ▪ Angiodysplasia

hernia consist of

Neck, sac and contents The protrusion of peritoneum with an organ or tissue through a defect in its surrounding abdominal walls

complication of abd hernia

-Irreducibility or incarceration, in which it cannot be reduced, or pushed back into place - Obstruction of any lumen, such as bowel obstruction in intestinal hernias -Strangulation -> ceased blood supply of the contents due to compression at the hernial orifice

diverticulim

blind puch leading off alimenatry tract lined by mucod that communicates with gut lumen -congenital: 3 layers -aquired: mucosa and submucsa

intestinal ischemia: causes

50%: arterial occlusion by thrombosis or embolizaiton 30%: nonocclusive intestinla ischemia: shcok, spesis, HF, MI, dehydraiton, hypotension, hypovolemia 10%: thrombosis of mesenteric veins

W5: intestine Flashcards

(43 cards)