Clinical Features: Non-Infectious Disease of the Small Intestine + Colon

Question 1

Hernias

Answer 1

No specific, unique clinical manifestation is mentioned in the textbook.
Most frequent cause of intestinal obstruction worldwide

Question 2

Adhesions

Answer 2

No specific, unique clinical manifestation is mentioned in the textbook.
~Most common cause of obstruction in the USA
~Results in internal herniation

Question 3

Volvulus

Answer 3

Nothing super unique about the presentation other than than the normal obstruction signs symptoms…

Abdominal distention, vomiting, pain, constipation, and TYMPANIC by percussion

HOWEVER, this can lead to TOXIC MEGACOLON

Question 4

Intussusception

Answer 4

No specific, unique clinical manifestation is mentioned in the textbook.

However,
~Most common cause of intestinal obstruction in children < 2 years old
~Young children: spontaneous or associated with VIRAL INFECTION, ROTAVIRUS VACCINE
~Maybe due to reactive hyperplasia of Peyer patches and other lymphoid tissue acting as a leading edge
~Older children/adults: due to intraluminal mass or tumor
~Surgical intervention is necessary

Question 5

Acute Ischemic Bowel Disease

Answer 5

Acute: The passage of blood or bloody diarrhea AS A SEQUELAE TO the desire to defecate

Originally could have had sudden onset of cramping, and LLQ pain.

Question 6

Chronic Ischemic Bowel Disease

Answer 6

Can masquerade as IBD

Question 7

Acute Radiation Enterocolitis

Answer 7

RADIATION EXPOSURE IN COMBINATION WITH THE FOLLOWING
Acute:
Anorexia, abdominal cramps, malabsorptive diarrhea

Question 8

Necrotizing Enterocolitis

Answer 8

~Not much is said in this chapter.
~Present when oral feeding is initiated
~Can lead to full-on transmural infarction

According to the internet, here is the overarching definition:
Necrotizing enterocolitis (NEC) is a devastating disease that affects mostly the intestine of premature infants. The wall of the intestine is invaded by bacteria, which cause local infection and inflammation that can ultimately destroy the wall of the bowel (intestine). Such bowel wall destruction can lead to perforation of the intestine and spillage of stool into the infant’s abdomen, which can result in an overwhelming infection and death.

Question 9

Angiodysplasia

Answer 9

SIGNIFICANT BLEEDING

Question 10

Malabsorbtion

Answer 10

Hallmark of malabsorption == steatorrhea

Accompanied by weight loss, anorexia, abdominal distention, borborygmi (gurgling), muscle wasting

Question 11

Pediatric Celiac Disease

Answer 11

Classically: onset 6-24 months (intro to peptide)
Irritability, abdominal distention, anorexia, chronic diarrhea, failure to thrive, weight loss, muscle wasting

Non-classic: later onset
Abdominal pain, nausea, vomiting, bloating, constipation
Arthritis, aphthous stomatitis, iron deficiency anemia, delayed puberty, short stature

Question 12

Adult Celiac Disease

Answer 12

Can be clinically silent or symptomatic
Chronic diarrhea, bloating, chronic fatigue, anemia (chronic iron and vitamin malabsorption)

Dermatitis herpetiformis: itchy, blistering skin lesion (10%)
Females 2:1, may be due to monthly menstrual bleeding impairing absorption

Question 13

Dermatitis Herpetiformis

Answer 13

~Extremely pruritic small vesicles

~Characteristic finding in 10% of celiac patients

Question 14

Environmental Enteropathy

Answer 14

~Distal bowel is most severely affected (young patients)
~Malabsorption, malnutrition, stunted growth, and defective
~Defective intestinal barrier function, chronic exposure to fecal pathogens, and other microbial contaminants, and repeated bouts of diarrhea within the first 2-3 years of life are likely involved

Question 15

Autoimmune Enteropathy

Answer 15

This is a severe, persistent diarrhea and autoimmune disease affecting young children
A deleterious form of AE is…
IPEX: immune dysregulation, polyendocrinopathy, enteropathy, X-linked

Question 16

Congenital Lactase Deficiency

Answer 16

Explosive diarrhea with watery, frothy stools and abdominal distention following dairy ingestion

Question 17

Abetalipoproteinemia

Answer 17

Very vague….
A pediatric patient that has:
Failure to thrive, diarrhea, steatorrhea

MORPHOLOGICAL FINDINGS ARE MORE SUGGESTIVE

Question 18

Chronic Radiation Enterocolitis

Answer 18

RADIATION EXPOSURE IN COMBINATION WITH THE FOLLOWING

Chronic: More indolent, may present as inflammatory enterocolitis

Question 19

Acquired Lactase Deficiency

Answer 19

• Abdominal fullness, diarrhea, flatulence following ingestion of lactose products
• Downregulation of lactase gene expression often following a viral or bacterial infection