ch. 14 slide 67-109

Question 1

4 types of intestinal obstructions

Answer 1

1. herniation
2. adhesions
3. intussusception- telescoping of prox. bowel into the distal segment
4. volvulus- twisting a loop of bowel

Question 2

meckel diverticulum

Answer 2

congenital; blind end pouch (SI); very common 2% of births, males 2x; MC asymptomatic

Question 3

hirschsprung disease

Answer 3

congenital aganglionic megacolon- Prox. bowel is obstructed
rectum; sigmoid colon
1:5,000
MC in males; Severe in females

Question 4

which arteries does ischemic bowel disease affect?

Answer 4

sup. & inf. mesenteric; Celiac

Question 5

Ischemic bowel disease can be caused by?

Answer 5

1. thrombosis: atherosclerosis
2. arterial embolism: MI
3. non-occlusive ischemia: heart failure, AAA
4. misc.: volvulus, aneurysm, irradiation/trauma

Question 6

Ischemic bowel disease acute vs. chronic

Answer 6

acute: sudden/severe abdom pain, nausea, vomit, bloody diarrhea
chronic: episodic bloody diarrhea, mimics IBD

Question 7

ischemic bowel disease has a 50% mortality

Answer 7

true; sepsis or shock

Question 8

what is angiodysplasia? where?

Answer 8

vascular lesion of colon-
in cecum or ascending colon
tortuous lesions, submucosal & mucosal vessels

Question 9

who does angyodysplasia affect? cause?

Answer 9

~1% of adults, >50 yrs old;
20% of lower intestinal bleeds;
idiopathic, mechanical stress

Question 10

hemorrhoids? caused by?

Answer 10

thin walled varices; anal & perianal vessels;

inc. intrabdominal pressure, straining, pregnancy

Question 11

hemorrhoids are associated with liver cirrhosis

Answer 11

true; portal HTN

Question 12

types of hemorrhoids

Answer 12

internal: above anorectal line
external: below anorectal line

Question 13

malabsorption manifests as?

Answer 13

chronic diarrhea; cant absorb fats, carbs, proteins, vit, minerals, electrolytes, water

Question 14

what is steatorrhea?

Answer 14

bulky, frothy, greasy, yellow/gray diarrhea

Question 15

what is dysentery?

Answer 15

bloody, painful, small volume diarrhea

Question 16

celiac disease aka?

Answer 16

celiac sprue

Question 17

what is celiac disease?

Answer 17

gluten sensitive enteropathy; non-infectious malab.
IMMUNE-MEDIATED reaction to gluten
IgA/IgG Ab’s

Question 18

Dermatitis herpetiformis is associated with?

Answer 18

celiac disease; 10% of patients get this.

pruritic, blisters on arms, legs, butt; neutrophils

Question 19

environmental enteropathy aka?

Answer 19

tropical sprue

Question 20

tropical sprue cycle

Answer 20

mucosal injury, malnut.,inflam

Question 21

how do you get tropical sprue? who is at risk?

Answer 21

living in or recently visited tropics;

MC affects 2-3 yr olds.

Question 22

types of tropical sprue

Answer 22

infectious: responds to antibiotics
autoimmune: villus flattening

Question 23

what is lactase def.? types?

Answer 23

cant digest lactase;

1. acquired (MC): youmg adulthood
2. congenital: auto recessive, rare, life threatening

Question 24

infectious enterocolitis

Answer 24

microbial infxn.- abdom pain, incontinence, perianal discomfort, hemorrhage

Question 25

how many children die globally each day from infectious enterocolitis? U.S.?

Answer 25

12,000/day 1/2 <5 yrs. old globally | 500 infants each YEAR in US

Question 26

cholera causes? transmitted by? MC in? lethal?

Answer 26

abrupt vomiting & watery diarrhea (rice water stools) fecal - oral route India/Africa lethal 50-70% in acute cases

Question 27

vibrio cholerae is?

Answer 27

comma shaped gram - bacteria

Question 28

campylobacter enterocolitis MC in? mc bacteria?

Answer 28

MC pathogen in U.S. E.Coli MC bacteria can cause reactive arthritis or GBS

Question 29

acute self- limited colitis?

Answer 29

<1 mo.- campylobacter, shigella, e.coli, salmonella

Question 30

pseudomembranous colitis aka?

Answer 30

antibiotic- associated colitis; ex: c-dif. overgrowth, colon inflammation: neutrophils enterotoxins->apoptosis

Question 31

risks for pseudomem. colitis?

Answer 31

hospitalization, older age, dec. immunity

Question 32

symptoms of pseudomem. colitis? Tx?

Answer 32

has pseudomembranes- cellular debris, leukocytes fever, watery diarrhea/dehydration, ab pain, leukocytosis Tx: vancomycin or metronidazole

Question 33

how do you get viral gastroenteritis? what is it?

Answer 33

direct contact with contaminated food or water infection that leads to inflammation 1/2 of all gastroenteritis is viral

Question 34

MC viral gastroent. in children? adults?

Answer 34

rotavirus- children | norovirus- adults

Question 35

parasitic diseases affects? caused by? what is MC? how do you get it?

Answer 35

- affects >1/2 world pop. - nematodes, hookworms, pinworms, tapeworms, protozoa - MC is giardia lamblia - spread by fecal contamination of water

Question 36

what is giardiasis?

Answer 36

Beaver fever- malab

Question 37

what is sigmoid diverticulum? aka?

Answer 37

acquired diverticulum-defects in the colon wall- diverticula; colonic diverticulosis

Question 38

risks of sigmoid diver.? Tx?

Answer 38

>60 years old 50%; refined foods; constipation 20% asymptomatic= diverticulitis; Increase fiber intake

Question 39

Irritable bowel syndrome (IBS) is?

Answer 39

altered bowel habits ie.: bloating, diarrhea, constipation, chronic/relapsing abdom pain

Question 40

IBS occurs in? Tx?

Answer 40

20-40 yr olds- females; 5-10 pop. | fiber, dec. carbs, stress management

Question 41

Crohn disease?

Answer 41

ENTIRE GI tract, MC in ileum, transmural inflammationMC

Question 42

Ulcerative colitis?

Answer 42

rectum, distal colon; mucosa & submucosa

Question 43

crohn disease symptoms?

Answer 43

melena, diarrhea, fever, SKIP lesions, ulcerations, arthritis - Fissures/strictures - granulomas - fibrosis

Question 44

which is MC crohns or UC?

Answer 44

Crohns- 1:500

Question 45

MC locations for Crohns?

Answer 45

terminal ileum Ileocecal valve cecum RLQ pain

Question 46

UC is associated with? how common is it?

Answer 46

``` superficial mucosal ulcerations - begins in rectum, goes proximal - has pseudopolyps Associated with polyarthritis, sacroilitis, AS, eye irritation, toxic megacolon -occurs 1:5,000 - 20-25 yr old - Smoking is bad for it. ```

Question 47

UC begins in?

Answer 47

rectum/distal colon

Question 48

active UC results in?

Answer 48

superficial ulceration, pseudopolyps

Question 49

inactive UC results in?

Answer 49

atrophy

Question 50

UC characteristics

Answer 50

``` not malab pseudopolyps non-granulomatous distal colon/rectum diffuse ulcerations little to no fibrosis ```