18. Small Bowel Disease

Question 1

What are 3 forms of congenital small bowel disease?

Answer 1

Meckel’s diverticulum
Atresia
Stenosis

Question 2

What is Meckel’s diverticulum?

Answer 2

Vitello-intestinal duct fails to disappear

Question 3

What is the difference between atresia and stenosis?

Answer 3

In atresia no lumen develops

In stenosis the lumen is narrowed

Question 4

What are non-infectious causes of inflammation in the small bowel?

Answer 4

Radiation enterocolitis
GvHD
IBD

Question 5

What is coeliac disease?

Answer 5

Atrophy of villi caused by an immune response to the gliadin fraction of gluten

Question 6

What genes are associated with coeliac disease?

Answer 6

HLA DQ2 and DQ8

Question 7

How is coeliac disease diagnosed?

Answer 7

Small bowel biopsy

Serum endomysial and TTG antibodies

Question 8

What is seen on histology in coeliac disease?

Answer 8

Villus atrophy
Crypt hyperplasia
Epithelial damage (TTG usually protects barrier)
Chronic inflammation

Question 9

What extra-GI disorders are associated with coeliac disease?

Answer 9

Dermolitis herpetiformis

Endocrine disorders

Question 10

What are the long term complications of coeliac disease?

Answer 10

EATL
Adenocarcinoma
Ulceration
Strictures caused by fibrosis
Splenic atrophy
Malnutrition

Question 11

What is giardiasis?

Answer 11

Giardia is a protozoa which causes patchy villus abnormality
Acquired by faecal contamination of water
Included in the differential for coeliac disease

Question 12

What is seen in giardiasis on histology?

Answer 12

Trophozoite (feeding stage of protozoa) along epithelial surface

Question 13

How is giardiasis detected?

Answer 13

Antigen test on stool

Question 14

What is Whipple’s disease?

Answer 14

Caused by an actinomycete can affect any organ

Question 15

What is seen on histology in Whipple’s disease?

Answer 15

Accumulation of lipids in lamina propia

Foamy macrophages full of pathogen

Question 16

What are the causes of obstruction in the small bowel?

Answer 16

Hernia
Adhesions
Intussusception
Volvulus

Question 17

What is intussusception?

Answer 17

Proximal segment of bowel telescopes into distal segment

Question 18

What is volvulus?

Answer 18

Bowel twists around its mesenteric base

Question 19

What benign neoplasms can be found in the small bowel?

Answer 19

Adenomas
Hamartomatous polyps (Peutz Jegher)
Lipomas, leimyomas

Question 20

What are the most to least common malignant neoplasms in the small bowel?

Answer 20

Primary GI lymphoma
Carcinoid tumours
Adenocarcinoma

Question 21

What are the causes of adenocarcinoma?

Answer 21

Long term Crohn’s or coeliac disease

FAP

Question 22

What forms of primary GI lymphomas can be found in the small bowel and what tumour markers do they have?

Answer 22

EATL (CD3+)

MALToma (CD20+)

Question 23

Which tumour marker shows how proliferative the cells are?

Answer 23

ki-67

Question 24

What are the symptoms of carcinoid syndrome?

Answer 24

Facial flushing
Intestinal hypermobility
Bronchoconstriction
RH abnormalities

Question 25

What are the causes of acute appendicitis?

Answer 25

Obstruction with mucin and bacterial infection

Due to generalised viral illness

Question 26

What are the types of acute appendicitis?

Answer 26

Acute focal
Acute suppurative
Gangrenous
Perforated

Question 27

What diseases can involve the appendix?

Answer 27

IBD
Sarcoid
Yersinia

Question 28

What tumours/tumour like conditions can involve the appendix?

Answer 28

Carcinoid
Mucocoele
Mucosal hyperplasia
Mucinous cystadenoma/cystadenocarcinoma