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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
exudative diarrhea
purulent, bloody diarrhea due to inflammatory disease persists during fasting
26
what is cystic fibrosis?
hereditary disorder of ion transport that affects fluid secretion in respiratory, GI and reproductive tracts
27
what is the clinical presentation of cystic fibrosis?
``` chronic lung disease pancreatic insufficiency steatorrhea malnutrition hepatic cirrhosis intestinal obstruction male infertility ```
28
what is the underlying etiology of cystic fibrosis?
meconium ileus: abnormally viscous secretions that obstruct organ passages
29
what is celiac disease?
gluten-sensitive enteropathy
30
what is the etiology of celiac disease?
combination of inheritance + environmental triggers which promotes activation of self-reactive lymphocytes
31
what is the pathogensis of celiac disease?
activation of CD8 T-cells, CD4 T-cells and B-cells in response to gliadin
32
What serologic tests are used to diagnose celiac disease?
Serum IgA endomysial antibodies (EMA) | Serum IgA tissue transglutaminase antibodies (tTG)
33
what are the demographics and clinical presentation of celiac disease in adults?
F > M 30-60 y/o ``` chronic diarrhea bloating chronic fatigue malabsorption dermatitis herpetiformis ```
34
what are the demographics and clinical presentation of celiac disease in children?
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
what are extraintestinal symptoms of celiac disease in children?
``` arthritis aphthous ulcers stomatitis anemia delayed puberty short stature ```
36
what is tropical enteropathy/tropical sprue?
enteric dysfunction common to populations with poor sanitation/hygiene *sub-Saharan Africa and aboriginal populations of Austrailia
37
what is the clinical presentation of tropical enteropathy?
malabsorption malnutrition stunted growth
38
what is autoimmune enteropathy?
an X-linked disorder characterized by severe persistent diarrhea
39
what is the severe familial form of autoimmune enteropathy?
IPEX (immune dysregulation polyendocrinopathy, enteropathy and X-linkage) caused by loss of function mutation in FOXP3
40
What is the pathogenesis of autoimmune enteropathy?
autoantibodies to enterocytes and goblet cells most common some patients have autoantibodies to parietal or islet cells neutrophils present in intestinal mucosa
41
congenital lactase deficiency
AR inherited mutation in gene encoding lactase very rare
42
what is the clinical presentation of congenital lactase deficiency?
occurs with first milk ingestion explosive diarrhea with watery, frothy stools abdominal distention
43
acquired lactase deficiency
downregulation of lactase gene expression common among Native Americans, African Americans, and Chinese populations
44
Microvillus inclusion disease
rare AR disorder of vesicular transport that leads to deficient brush-border assembly
45
What is the etiology of MID?
mutation in MYO5B gene which encodes for motor proteins accumulation of abnormal apical vesicles containing microvilli and various membrane components
46
what is the diagnostic tool for MID?
CD10 immunohistochemistry
47
what is the demographic for MID?
European, Middle Eastern and Navajo Native American populations
48
what is the treatment of MID?
total parenteral nutrition and small bowel transplantation
49
Abetalipoproteinemia
a rare AR disease characterized by an inability to assemble triglyceride-rich lipoproteins
50
what is the clinical presentation of abetalipoproteinemia?
presents in infancy failure to thrive diarrhea steatorrhea *acanthocytes in peripheral blood
51
what is the etiology of abetalipoproteinemia?
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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