2 Dis of Sm Bowel and appendix [5] devaraj? Flashcards
Tumors of the appendix
Carcinoid (0.5%) - most common
- neuroendo tumor with rare chance of metastasis
- carcinoid syndrome with metastasis = serotonin syndrome
Epithelial - rare
- show same range as colon polyps and cancers
(dysplasia to adenocarcinoma )
Serotonin syndrome
episodic flushing
diarrhea
wheezing
right sided heart valve disease
- can present from carcinoid syndrome with mets
4 types of diarrhea
- watery
- steatorrhea
- inflammatory/exudative
- fxnal (IBS)
watery diarrhea
osmotic/secretory
osmotic: carbohydrate malabsorption or osmotic laxatives
- poorly absorbed luminal osmols
Secretory: bacterial toxins, neuroendocrine tumors, ileal bile salt malabsortion, STIMULANT laxatives, disordered motility regulation
- V. cholerae, Enterotoxogenic E.coli , Giardia lambia
How to differentiate btwn osmotic and secretory diarrhea
Normal stool osmolality = 290
Osm gap = 290-2(stool sodium+potassium)
if difference is >50 = osmotic
- makes sense, more ions present in stool
if
Steatorrhea/fatty diarrhea
malabsorption syndromes
- celiac, whipple’s
Short bowel syndrome
- after surgery
- Bacterial overgrowth
Maldigestion/malabsorption
- pancreatic insufficiency
- inadequate luminal bile salt [ ]
Inflammatory/Exudative diarrhea
often bloody
Infecton
IBD
Ischemia
Infxn:
shigella, campylobacter, ETEC, salmonella, Yersinia, C. Diff
functional (IBS) diarrhea
abdominal pain and altered bowel habits in absence of organic cause
- pain improves with defecation
- back and forth btwn constipation + diarrhea
concerning sx: weight loss, rectal bleed, anemia, nocturnal symp, electrolyte abnormalities, elevated inflamm marks.
Clinical signs of malabsorption
weight loss
diarrhea
steaorrhea
vitamin deficiency
pale, bulky, malordorous stool - difficult to flush
Causes of malabsorption
surgery bacterial overgrowth meds - phenytoin pancreatic insufficiency liver disease intestinal inflammation/villus flattening - celiac, whipples disease, tripical sprue Ulceration ischemia infiltration - amyloidosis
malabsorption of this vit leads to...? Vit A → Vit D → Vit E → Vit K →
Vit A → night blindness (xeropthalmia)
Vit D → osteomalacia (common)
Vit E → hemolytic anemia
Vit K → clotting dysfxn (common)
Pancreatic insufficiency + its affect on maldigestion
90% of pancreas burned out → lipid maldigestion FIRST
(protein and carb malab are rare)
- chronic pancreatitis or CF
How does gastric bypass cause maldigestion?
not actually causing malabsorption, rather it is a mixing prob
causes inadequate mixing of food with biliary and pancreatic secretions.
- vit deficiencies (so give multivit!)
Celiac Spruce (gluten-sensitive enteropathy)
- what is it?
- histo?
- gross?
inflammatory disease of SMALL INT with consumption of wheat, barley, or rye
Loss of villi/villous flattening
Crypt hyperplasia
inter-epithelial lymphocyte
Scalloping mucosa
(80% are asymptomatic)
Celiac spruce is associated with MHC _____. and All have antibodies to _______, which leads to a _____ T cell response
Class II
Ab to tissue transglutaminase
CD4+
