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GI II > Ch. 17 Pathology: Obstruction and Malabsorption > Flashcards

Ch. 17 Pathology: Obstruction and Malabsorption Flashcards

1
Q

What part of the bowel is most prone to obstruction and why?

A

small intestine due to its relatively narrow lumen

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2
Q

What accounts for most mechanical obstructions?

A

Hernias (most common wordwide)
Adhesions (most common in US)
Intussusception
Volvulus

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3
Q

What is the most common cause of functional obstruction?

A

post-operative ileus

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4
Q

What are clinical manifestations of intestinal obstruction?

A

Abd pain
Distention
Vomiting
Constipation

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5
Q

Where is a volvulus most likely to occur?

A
  1. loops of sigmoid colon
  2. cecum
  3. small bowel
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6
Q

what is the most common cause of obstruction in children?

A

intussusception

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7
Q

what contributes to the tolerability of the intestine progressive loss of blood supply?

A

collateral vessels between proximal celiac, distal pudendal, and iliac circulations

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8
Q

Occlusion of which vessel provides the worse outcome of bowel ischemia?

A

superior mesenteric artery occlusion

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9
Q

what is the etiology of acute vascular obstruction?

A 
artherosclerosis 
AAA
cardiac mural thrombi
vasculitis
mesenteric venous thrombosis
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10
Q

what is the etiology of chronic vascular obstruction?

A

cardiac failure
shock
dehydration
vasoconstrictive drugs

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11
Q

what is the pathogenesis of vascular obstruction?

A

hypoxic injury followed by reperfusion injury

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12
Q

what three major variables determine severity of ischemia?

A
  1. severity of vascular compromise
  2. time frame
  3. vessels affected
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13
Q

what are the demographics of ischemic bowel disease?

A

> 70 y/o

F > M

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14
Q

what is the clinical presentation of acute bowel ischemia?

A

sudden onset LLQ cramping
desire to defecate
hematochezia

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15
Q

what mimics the presentation of ischemia?

A

CMV

radiation enteritis

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16
Q

where is angiodysplasia most common?

A

cecum or right colon

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17
Q

what is angiodysplasia?

A

lesion characterized by malformed submucosal and mucosal blood vessels

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18
Q

what are the demographics of angiodysplasia?

A

> 60 y/o

accounts for 20% of major intestinal bleeding episodes

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19
Q

what is the hallmark of malabsorption?

A

steatorrhea: greasy, foul-smelling, yellow/clay-colored stool

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20
Q

what is dysentery?

A

painful, bloody, small-volume diarrhea

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21
Q

secretory diarrhea

A

isotonic stool that persists during fasting

22
Q

osmotic diarrhea

A

excessive osmotic forces exerted by unabsorbed luminal solutes

resolves with fasting

23
Q

what disorder classically presents with osmotic diarrhea?

A

lactase deficiency

24
Q

malabsorptive diarrhea

A

generalized failure of nutrient absorption

associated with steatorrhea

resolves with fasting

25
Q

exudative diarrhea

A

purulent, bloody diarrhea due to inflammatory disease

persists during fasting

26
Q

what is cystic fibrosis?

A

hereditary disorder of ion transport that affects fluid secretion in respiratory, GI and reproductive tracts

27
Q

what is the clinical presentation of cystic fibrosis?

A 
chronic lung disease
pancreatic insufficiency
steatorrhea
malnutrition
hepatic cirrhosis
intestinal obstruction
male infertility
28
Q

what is the underlying etiology of cystic fibrosis?

A

meconium ileus: abnormally viscous secretions that obstruct organ passages

29
Q

what is celiac disease?

A

gluten-sensitive enteropathy

30
Q

what is the etiology of celiac disease?

A

combination of inheritance + environmental triggers which promotes activation of self-reactive lymphocytes

31
Q

what is the pathogensis of celiac disease?

A

activation of CD8 T-cells, CD4 T-cells and B-cells in response to gliadin

32
Q

What serologic tests are used to diagnose celiac disease?

A

Serum IgA endomysial antibodies (EMA)

Serum IgA tissue transglutaminase antibodies (tTG)

33
Q

what are the demographics and clinical presentation of celiac disease in adults?

A

F > M
30-60 y/o

chronic diarrhea
bloating
chronic fatigue
malabsorption
dermatitis herpetiformis
34
Q

what are the demographics and clinical presentation of celiac disease in children?

A

F = M

6-24 months: irritability, abd distention, chronic diarrhea, failure to thrive and weight loss

> 2 y/o: abdominal pain, nausea, vomiting, bloating, constipation

35
Q

what are extraintestinal symptoms of celiac disease in children?

A 
arthritis
aphthous ulcers
stomatitis
anemia
delayed puberty
short stature
36
Q

what is tropical enteropathy/tropical sprue?

A

enteric dysfunction common to populations with poor sanitation/hygiene

*sub-Saharan Africa and aboriginal populations of Austrailia

37
Q

what is the clinical presentation of tropical enteropathy?

A

malabsorption
malnutrition
stunted growth

38
Q

what is autoimmune enteropathy?

A

an X-linked disorder characterized by severe persistent diarrhea

39
Q

what is the severe familial form of autoimmune enteropathy?

A

IPEX (immune dysregulation polyendocrinopathy, enteropathy and X-linkage)

caused by loss of function mutation in FOXP3

40
Q

What is the pathogenesis of autoimmune enteropathy?

A

autoantibodies to enterocytes and goblet cells most common

some patients have autoantibodies to parietal or islet cells

neutrophils present in intestinal mucosa

41
Q

congenital lactase deficiency

A

AR inherited mutation in gene encoding lactase

very rare

42
Q

what is the clinical presentation of congenital lactase deficiency?

A

occurs with first milk ingestion

explosive diarrhea with watery, frothy stools
abdominal distention

43
Q

acquired lactase deficiency

A

downregulation of lactase gene expression

common among Native Americans, African Americans, and Chinese populations

44
Q

Microvillus inclusion disease

A

rare AR disorder of vesicular transport that leads to deficient brush-border assembly

45
Q

What is the etiology of MID?

A

mutation in MYO5B gene which encodes for motor proteins

accumulation of abnormal apical vesicles containing microvilli and various membrane components

46
Q

what is the diagnostic tool for MID?

A

CD10 immunohistochemistry

47
Q

what is the demographic for MID?

A

European, Middle Eastern and Navajo Native American populations

48
Q

what is the treatment of MID?

A

total parenteral nutrition and small bowel transplantation

49
Q

Abetalipoproteinemia

A

a rare AR disease characterized by an inability to assemble triglyceride-rich lipoproteins

50
Q

what is the clinical presentation of abetalipoproteinemia?

A

presents in infancy

failure to thrive
diarrhea
steatorrhea

*acanthocytes in peripheral blood

51
Q

what is the etiology of abetalipoproteinemia?

A

Mutation of MTP gene

Plasma is devoid of lipoproteins containing apolipoprotein B

Failure to absorb essential fatty acids leads to fat-soluble vitamin deficiencies and lipid membrane defects

GI II (16 decks)

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