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Gastro > Diseases of small intestine > Flashcards

Diseases of small intestine Flashcards

1
Q

Duodenum is responsible for absorbing what?

A

Iron**, calciuim, phophorus, mag, copper, thiamin, riboflavin

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2
Q

Jejunum absorbs what?

A

ADEK and **Folate

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3
Q

Ileum

A

B12, bile salts/acids

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4
Q

What is Celiac disease

A

Gluten sensitive enteropathy

Diffuse damage to the proximal small intestinal mucosa (immune)

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5
Q

Celiac disease is “Grossly” underdiagnosed. What clinical signs should we be on the look out for?

A

GI issues including **Steatorrhea, flatulance, borborygmi, weakness/muscle wasting

Extraintestinal - Fatigue, depression, Iron def, transaminitis, *****Dermatitis herpetiformis

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6
Q

What is dermatitis herpetiformis

A

Pruritic papules and vesicle (herpes like)

Extensor surfaces of extremities, trunk, scalp, neck

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7
Q

What labs should be drawn for Celiac?

A

CBC, CMP, UA (rule out stuff)

Specific serology:
IGAtTG antibody- ***Test of Choice… if neg, draw serum IgA (maybe IgA def.)

IgG-deamidated gliadin peptides (DGPs)
-If you have an identified IgA def

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8
Q

Describe IgA function and abundance

A

Function - Protect mucosal tissue from the microbial invasion and maintain immune homeostasis

*most abundant

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9
Q

If we have positive serology for celiac disease, what should we do to confirm or exclude diagnosis?

A

Mucosal biopsy of **proximal small intestine

Looking for blunting or atrophy of intestinal villi

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10
Q

Describe the overarching diagnostic approach for celiac

A

HPE
Serologic testing algorithm
Try to eliminate all gluten (2-3 weeks should be good)
Mucosal biopsy

Refer to dietician.

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11
Q

Celiac disease carries a SLIGHT increased risk of what?

A

lymphoma and adenocarcinoma

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12
Q

What is Whipple disease?

A

Rare multisystem illness caused by T. Whippelii

Common in white males 30-50

No human spread

Contact with sewage/waste

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13
Q

What is the classic patient presentation with whipple disease?

A

Pt w/

  1. Migratory arthralgia (large joint)
  2. Diarrhea (flatulance, steatorrhea)
  3. ABD pain, weight loss, fever
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14
Q

How do we establish diagnosis for whipple disease?

A

Mucosal biopsy w/ evidence of bacterium

“Foamy macrophages”

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15
Q

How do we treat whipple?

A
  1. IV ceftriaxone x 2 wks

2. THEN** (not or) TMP-SMX DS PO (septra) x 1 year

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16
Q

What is tropical sprue? Where is it found?

A

Tropics (no shit) N/S of equator to 30 degrees

Chronic diarrheal disease characterized by entire small intesting involvment and ** folic acid and B12

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17
Q

What are the hallmark s/sx of tropical sprue

A 
CHRONIC diarrhea
Steatorrhea
weight loss
anorexia
malaise
**B12 and Folate deficiency (glossitis and chelitis)
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18
Q

What labs/procedures do we use to diagnose tropical sprue?

A

CBC - Megaloblastic anemia

Endoscopy w/ biopsy - Flattening of duodenal folds and blunted villi w/ elongated crypts

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19
Q

What is prevention and treatment of Tropical sprue?

A

Prev = boil water and peel fruit

TX = Septra x 6 months (TMP-SMX). Folate and B12.

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20
Q

What happens to malabsorbed lactose?

A

It gets fermented by intestinal bacteria which produces gas and organic acids.

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21
Q

As intake of lactose increases in lactade deficiency, what else increases?

A

Symptoms - Small –> asymptmatic, Large = osmotic diarrhea

22
Q

Should signs of general malabsorption be present in lactase deficiency?

A

No… If wt loss, look for other diagnosis

23
Q

What are our treatment options for Lactase deficiency

A

Presumptive = Stop 2-3 weeks and observe

Diagnose = Hydrogen breath test ***

Then treat with *Titration to patient symptoms.

24
Q

What products are available for people with lactase deficiency?

A

Lactase-enhanced products

Lactase enzyme replacement supplements

25
Q

When should we consider Bacterial Overgrowth in patients?

A
  1. Pt on chronic PPI (gastric *achlorhydria)
  2. Anatomic abnormality of small intestine
  3. Small intestine motility disorder
  4. Gastrocolic or coloenteric fistula (crohns, cancer, surg resect)
26
Q

What are the symptoms of bacterial overgrowth?

A

Flatulance, wt loss, abd pain, diarrhea, steatorrhea, **Macrocytic anemia

Pair w/ patient risk catagory*******

27
Q

How do we treat a bacterial overgrowth

A

Cipro –> Augmentin –> Rifaximin

28
Q

Removing a segment of the small intestine can cause what? What is this?

A

Short Bowel Syndrome

Malabsorption secondary to shit being gone… Depends on the length, location etc…

29
Q

An acute paralytic ileus (AKA adynamic or post-operative) lacks what? What is it usually secondary to?

A

No mechanical obstruction

ABD surgery (immediate post)
Severe illness (inpatient)
Intestinal motility drugs (opiods, Antichols)
30
Q

What S/Sx do we look for in Acute Paralytic Ileus?

A

CONSTANT abdominal pain - diffuse
NO abdominal TTP - no peritonitis
DIMINISHED bowel sounds - or absent
N/V and distention*

31
Q

What is the diagnostic test of choice for acute paralytic ileus?

A

Plain ABD x-ray shows gas filled loops of either bowel

Also, get labs to see if you need to fix stuff.

32
Q

How do we treat Acute paralytic ileus?

A

Supportive

Tx illness, pain, fluid/electrolytes, *bowel rest, *Nasogastric decompression if sever or vomit

33
Q

What is a Chronic Intestinal Psuedo Obstruciton

A

S/SX similar to gastroparesis

Looks like an obstruction but there isnt one. (Psuedo….)

34
Q

What should we do to diagnose CIPO?

A

CT or endoscopy to r/o obstruction

If none, fix malnutrition or electrolyte imbalance…

Refer them to GI

35
Q

Small bowel obstruction is most commonly attributed to what?

A

Postoperative adhesions or hernias

36
Q

Besides the most common cause, what other things can cause SBO?

A 
Neoplasms
Strictures
Foreign Body
Intussusception
Gallstones (gallstone ileus)
37
Q

What are the risk factors for SBO?

A 
Prior ABD or pelvic surgery **
ABD wall or groin hernia **
Prior irradiation
Foreign body ingestion
Neoplasm shit and inflammation
38
Q

How will a patient present with an SBO?

A

COLICKY abdominal pain
Nausea, vomiting, OBSTIPATION

ABD DISTENTION w/ TYMPANY
HYPERACTIVE–> HYPOACTIVE sounds
dehydrated

39
Q

How do we workup a suspected SBO patient?

A

CBC, CMP, UA, Type and cross for surg

Plain ABD film**
CT if pt has systemic signs or Localized ABD pain (r/o strangulation)*

40
Q

We have diagnosed a SBO. How do we treat the pt?

A

EARLY SURGICAL CONSULT
ADMIT this patinet

TX supportive : Fluid resus, Decomp bowel, pain, anti emetic.

41
Q

What is a gallstone ileus? Who is most likely to have this?

A

Impaction of gallstone in ileum after going through biliary-enteric fistula….

Must have gallstones (Four F’s)

42
Q

Telescoping intestine (invagination) is known as what? What can it cause? What is seen in kids?

A

Intussusception

Bowel Obstruction

Currant Jelly Stool (red)

43
Q

Primary malignancy for SI is _______. But a neoplasm may cause what?

A

Rare

Intussusception

44
Q

Differentiate Adenocarcinoma and lymphoma of the small intestine

A

Adenocarcinoma - duodenum of prox jejunum. Obstruction, Chronic GI bleed or weight loss

Lymphoma - assoc w/ aids, immunosuppres, Crohns

45
Q

What is Protein-losing enteropathy? Why would we get it? What should we do about it

A

Loss of serum protein (hypoalbuminemia) into the GI tract

Secondary to established disorder

CMP/BMP to diagnose
Replace it via diet or straight up Albumin

46
Q

List types of Mesenteric Ischemia

A

Acute arterial occlusion - emboli/thrombus

Mesenteric venous thrombosis

Non-occlusive - Low card output, Vasospasm

47
Q

What is the classic physical exam sign for Mesenteric Ischemia?

A

Pain out of proportion to exam

**look at history of cardiac issues too

48
Q

What test diagnosis Mesenteric ischemia? How do we treat it?

A

CT angiography

Admit
Papaverine* - smooth muscle relaxer
Thrombolytics
Surgical referral

49
Q

Meckel’s diverticulum is a _______ abnormality, it follows the rules of ______

A

Congenital (most common)

Two

50
Q

What is the rule of twos?

A

Meckels diverticulum

2% population
2:1 male-femal
2 types of mucosa
2 years old or younger

51
Q

How will a patient with Meckel’s present? How do we diagnose? How do we treat?

A

GI bleed from mucosa with Abdominal pain (like apendicitis pain)

Kid under 10 = painless bleeding w/ IBD symptoms

Adults under 40 w/ unidentified GI bleed

**Diagnose w/ capsule endoscopy of Meckels nuclear (99m tech pertech)

Tx = Stabilize and refer to surgery.

Gastro (9 decks)

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