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1.2 Lectures > Week 5 (Acquired Disorders of the GI Tract) > Flashcards

Week 5 (Acquired Disorders of the GI Tract) Flashcards

1
Q

Small Intestine Length; Large Intestine Length

A

600-800cm; 150cm

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2
Q

Function of Intestines

A

Blood Supply, innervation, lymphatics
Digestion and absorption of nutrients and vitamins
Electrolyte absorption and secretion
Fluid secretion and absorption
Immunologic function
Elimination

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3
Q

What are the two kinds of bypasses in the GI tract for weight loss?

A

Jejunal Ileal Bypass, Gastric Bypass

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4
Q

Which Bypass is depicted here?

A

Jejunal Ileal Bypass

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5
Q

Which Bypass is depicted here?

A

Gastric Bypass

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6
Q

What are the disorders of the small and large intestines?

A

Embryologic
Anatomic or mechanical
Inflammatory
Functional
Neoplasia
Vascular

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7
Q

What are common symptoms and signs of most acquired disorders of the small and large intestines?

A

Pain and tenderness

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8
Q

Pain that is described as a vague, dull, aching discomfort is known as ______ pain

A

visceral

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9
Q

Where is visceral abdominal pain usually localized?

A

In the midline corresponding with the embryological origin of the alimentary tract

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10
Q

Where is Somatic (Parietal) abdominal pain localized?

A

The area of contact of inflamed viscera with the Parietal peritoneum which is innervated by the somatic nerve supply of the same respective dermatome

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11
Q

Describe the severity over time for acute abdominal pain caused by perforated viscus and vascular disaster (ruptured aneurysm, mesenteric infarction, ischemic bowel)

A

Increases very quickly and then levels out

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12
Q

What is the proper treatment for acute abdominal pain caused by perforated viscus and vascular disaster, and how urgent is it?

A

Surgery; Now!!!!!

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13
Q

Describe the severity over time for acute abdominal pain caused by Gastroenteritis

A

Severity increases gradually and then decreases gradually

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14
Q

What is the treatment for acute abdominal pain caused by gastroenteritis, and how urgent is it?

A

Supportive care; not urgent at all

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15
Q

Describe the severity over time for acute abdominal pain caused by appendicitis and uncomplicated diverticulitis

A

steadily increases over a long period of time

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16
Q

What is the proper treatment for acute abdominal pain caused by appendicitis and uncomplicated diverticulitis, and what is the urgency to provide it?

A

Treatment ranges from antibiotics to IR drainage to surgery; moderate urgency

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17
Q

What causes of acute abdominal pain display this amount of severity over time?

A

Small bowel obstruction, gallbladder pain, renal colic, labor/child birth

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18
Q

What is the proper treatment for acute abdominal pain caused by small bowel obstruction, gallbladder pain, renal colic, or labor/child birth? What is the degree of urgency?

A

Ranges from close observation to surgery; ranges from no urgency to significant urgency

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19
Q

What is the age range/median age of those with appendicitis?

A

5-40/28

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20
Q

Do males or females have a higher lifetime risk of appendicitis?

A

Males (8.6%) more likely than females (6.7%)

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21
Q

Do men or women have a higher risk of appendectomy?

A

Women (23.1%) more likely than men (12.0%)

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22
Q

Age range for (women) with appendectomy

A

35-44

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23
Q

Describe Gross and Microscopic acute/uncomplicated obstruction of the appendix lumen

A

Gross: Serosal vessel injection, edema
Microscopic: Neutrophil infiltration of muscularis, edema, inflammation and necrosis of mucosa, microabscesses of appendicular wall, vascular thrombosis

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24
Q

Describe Gross and Microscopic Gangrenous obstruction of the appendix lumen

A

Gross: Fibrinopurulent exudate, necrosis
Microscopic: transmural inflammation and necrosis, vascular necrosis

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25
Describe Gross Perforated obstruction of the appendix lumen
Perforation, pus, abscess
26
Is this uncomplicated, gangrenous, or perforate obstruction of the appendix lumen?
Gangrenous
27
Is this uncomplicated, gangrenous, or perforate obstruction of the appendix lumen?
Uncomplicated
28
Is this uncomplicated, gangrenous, or perforated obstruction of the appendix lumen?
perforated
29
What is the clinical presentation of appendicitis?
30
Review where referred abdominal pain goes to
31
What is the treatment of appendicitis?
32
Describe the bioactive amines, peptides, and growth factors of GI neuroendocrine cells (APUDoma) that give rise to gastrointestinal neuroendocrine tumors (GI-NET)
Bioactive amines: neuron-specific enolase (NSE), 5-hydroxytryptamine ( 5H or serotonin), and 5-hydroxytryptophan (5-HTP) Peptides: chromogranin A, pancreatic polypeptide, calcitonin, tachykinins (neurokinin A and substance P) Growth factors: Transforming growth factor-Beta), platelet-derived growth (PDGF), endocrine growth factor (EGF), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), including the receptors
33
Describe the gross and microscopic histology of gastrointestinal neuroendocrine tumors (GI-Net)
Gross: solid, small primary tumors; small bowel: desmoplastic reaction Microscopic: Enterochromaffin (EC) cell carcinoid: argentaffin staining properties, pleomorphic secretary granules, no necrosis, low mitoses; patterns: (1) nodular or insular pattern; (2) trabecular pattern; (3) acinar and tubular pattern; (4) atypical solid pattern
34
Are incidences of carcinoids more common in bronchopulmonary or the gastrointestinal tract?
More common in the Gastrointestinal tract (67%) than the bronchopulmonary (25%)
35
What is the clinical presentation of appendix carcinoids?
acute appendicitis, incidental/asymptomatic
36
What is the recommended treatment for appendix carcinoids?
Simple appendectomy: tumor <2cm, negative margin Right hemicolectomy: tumor size >2cm, lymphatic invasion, lymph node involvement, spread to the mesoappendix, tumor-positive resection margins, cellular pleomorphism with a high mitotic index
37
What is the clinical presentation of acquired disorder of the GI tract within the small intestine?
Obstruction, bleeding, incidental/asymptomatic
38
Describe localized and metastatic treatment for acquired disorders within the small intestine
Localized: resection with lymph node dissection; Look/feel for second primary Metastatic: Primary tumor: resection/internal bypass; Metastases: resection, ablation, chemoembolization
39
Review the definition and key features of carcinoid syndrome
40
Review the pathophysiology of Intussusception of the small intestine; provide a definition
41
Describe the clinical presentation of intussusception
Small bowel obstruction Symptoms: cramping, nausea, vomiting, abdominal pain Signs: distension, diffuse tenderness (early) focal tenderness (late) Imaging: CT
42
Review treatment of Intussusception for both children and adults
43
Review the pathophysiology of adhesions
44
Is this Fibrinous: self-limited or Fibrous: permanent adhesion?
Fibrous: permanent
45
Is this Fibrinous: self-limited or Fibrous: permanent adhesion?
Fibrinous: self-limited
46
Review the clinical manifestation of adhesions (small bowel obstruction)
Bowel kinds at fixed point or through internal hernia under adhesive band Fluid, swallowed air and bacterial gas accumulation within obstructed limb Bacterial overgrowth Venous → Arterial thrombosis Epithelial ischemia (4-6 hours) → necrosis (8-12 hours) → transmural necrosis (??? hours)
47
Review the Clinical Presentation of adhesions (symptoms, signs, laboratory, and radiographic)
Symptoms: mid-abdominal pain, vomiting, obstipation, and abdominal distention Signs: Acutely ill, abdominal distention, systemic evidence of intravascular volume depletion, auscultation of the abdomen reveals periods of increased bowel sounds separated by intervals of relative quiet (high pitched or musical, borborygmi are pronounced rumbling bowel sounds that correspond with paroxysms of cramping abdominal pain Laboratory: volume contraction, leukocytosis, lactic acidosis (late) Radiographic: plain films, computed tomography (preferred)
48
Review the treatment of adhesions
49
What are the most common causes of colonic obstruction?
Adenocarcinoma Volvulus Stricture (ischemic, diverticulitis)
50
Review the pathophysiology of Volvulus
51
Describe the symptoms and signs of volvulus
Symptoms: periumbilical or hypogastric pain, abdominal distention, obstipation Signs: abdominal distension, minimal tenderness
52
Describe the clinical presentation of Sigmoid volvulus and Cecal volvulus
Sigmoid volvulus: 60-80 years of age with concomitant medical problems Cecal volvulus: younger, associated with chronic constipation/laxative use, prior surgery, 1/3 with more distal obstruction lesion
53
Describe the treatment for Cecal and Sigmoid volvulus
Cecal: right hemicolectomy Sigmoid: endoscopic or radiographic decompression, elective sigmoid colectomy, urgent colectomy if ischemic physiology
54
What is the pathophysiology of Ischemic Colitis?
* SMA distribution-Right sided colitis * Associated with superior mesenteric artery occlusion or embolus * Involves small bowel as well * IMA distribution-Left sided colitis * Hypoperfusion and reperfusion injury * Relative low blood flow during activity * Lack of autonomic stimulation
55
What can cause Ischemic Colitis?
Any disorder that leads to mechanical or functional hypo perfusion * Acute pancreatitis * Allergy * Amyloidosis * Heart failure/cardiac arrhythmias * Hematologic disorders * Coagulopathies * Infection * IMA thrombosis * Long-distance running * Medications and toxins * Pheochromocytoma * Ruptured ectopic pregnancy * Shock * Strangulated hernia * Surgery/Procedures – AAA repair * Thromboembolism * Myxoma (left atrial) * Trauma (blunt or penetrating) * Vasculitis and vasculopathy * Volvulus
56
What is the clinical presentation of Ischemic Colitis?
* Clinical symptoms: –Sudden cramping, mild, left lower abdominal pain –Urgent desire to defecate –Passage within 24 hours of bright red or maroon blood or bloody diarrhea –Mimics diverticulitis * Spectrum –Mild: mucosal and submucosal hemorrhage and edema, with or without partial necrosis and ulceration of the mucosa. –Moderate: chronic ulcerations, crypt abscesses, and pseudopolyps develop, * Mimic inflammatory bowel disease * Pseudomembranes also may be seen. * Iron-laden macrophages and submucosal fibrosis are characteristic of ischemic injury. –Severe: muscularis propria is replaced by fibrous tissue, forming a stricture. –Most-severe: transmural infarction, perforation
57
What is a true diverticulum?
–All layers of the hollow viscus wall. –Examples: appendix, Meckel’s
58
What is a pseudo diverticulum
Herniation of mucosa and submucosal layers through muscularis and serosa. –Examples: colonic diverticulum/osis/it is, duodenal/small bowel diverticulum
59
What is the pathophysiology of a diverticulum?
* Herniation of mucosa and submucosal thru colonic wall at site of penetration of vasa recta into bowel wall. * Causes –Altered colonic wall structure –Abnormal motility producing increased intraluminal pressures –Dietary fiber
60
What is the clinical presentation of Diverticulosis/Diverticulitis?
* Diverticulosis: –Asymptomatic (80%) * 12-49%ofpeople * <10%age<40,50-66%age>80 –Bleeding * Occult vs massive * Diverticulitis * Uncomplicated – localized inflammation * Complicated – abscess, perforation, fistula Uncomplicated *Signs and symptoms – LLQ pain – uncomplicated or abscess – Generalized pain – complicated with perforation – Pneumaturia – fistula to bladder – Obstruction - stricture – Fever, leukocytosis Radiology - CT abdomen/pelvis
61
What are the stages of the Hinchey Classification of colonic diverticular perforation?
STAGE DEFINITION I Confined pericolic abscess II Distant abscess (retroperitoneal or pelvic) III Generalized peritonitis caused by rupture of a pericolic or pelvic abscess (not communicating with the colonic lumen because of obliteration of the diverticular neck by inflammation) IV Fecal peritonitis caused by free perforation of a diverticulum (communicating with the colonic lumen)
62
How would you treat diverticulosis?
– Asymptomatic * Fiber,water * Noneedforsurgery * Noneedtoavoidseedsorpopcorn * Justeatbetter – Bleeding * Colonoscopiccontrol(clips,coagulation) * Angiographicembolization * Surgery – After appropriate localization – Exsanguinating hemorrhage: total colectomy
63
How would you treat Diverticulitis?
* Uncomplicated * Singleepisode:bestsupportivecare * Multipleepisodes:resectionforrecurrent(>4)episodes * Complicated * Abscess * Percutaneous drainage, delayed elective colectomy * Perforation * Emergency colectomy with colostomy (Hartmann’s) * Fistula * Elective colectomy * Obstructionfromstricture * Endoscopic stenting * Surgery – elective colectomy
64
Diverticulosis vs Diverticulitis
* Diverticulosis: multiple diverticula * Diverticulitis: inflammation in setting of diverticulosis
65
How would you treat ischemic colitis?

1.2 Lectures (9 decks)

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