Diseases of the small bowel

Question 1

List the tumors of the Appendix.

Answer 1

very rare:
Carcinoid-neuroendocrine tumor- most common, mets rare, carcinoid syndrome( seratonin syndrome, episodic flushing, diarrhea, wheezing, right sided heart valve disease)

Benign- mucinous cystadenoma, villous adenoma,

malignant tumors- adenocarcinoma, lymphoma
secondary tumors

Question 2

Name four types of diarrhea based on stool characteristics and give examples of each.

Answer 2

Fatty-
-malabsorption- celiacs, whippleShort bowel syndrome, small bowel bacterial overgrowth

-maldigestion- pancreatic insufficency, inadequate luminal bile salt concentration (chronic liver disease, bilairy obstruction

Watery-
-osmotic–> osmolar gap > 50 carb malabsoprtion (lactose, sorbitol (chewing gum), fructose), somotic laxatives (mg containing, phosphate sulfate)( colonoscopy preps)

-secretory–> osmolar gap

Question 3

causes of fat malabsorption- use sudan fat stain

Answer 3

Surgery- gastric bypass, small bowel resection

Bacterial overgrowth

meds- Cholesteramine, phenytoin, folate

Pancreatic insufficiency

Liver disease

Intestinal inflammation, villous flattening- celiac, whipple, tropical sprue

ulceration

ischemia

infiltration-amyloidosis

Question 4

Describe the pathogenesis, diagnosis and treatment of celiac disease.

Answer 4

Signs- abd distention, abd pain, anorexia, bulky sticky pale stools (staetorrhea), Diarrhea, flatulence, failure to thrive, vomiting
atyp- iron def anemia, dermatitis herpetiformis, increased liver enzymes, cerebellar ataxia, osteoporosis, oral ulcers
pathogenesis
-auto immune associated, HLA DQ2 HLA DQ8, CD4+ T cell response, all dev antibodies to transglutaminase
Dx- biopsy gold standard, anti tsissue transglutaminase antibodies,
Tx- gluten free diet

Question 5

Describe the pathogenesis, diagnosis and treatment of small bowel bacterial overgrowth.

Answer 5

causes
- anatomic abnormalities (diverticula, blind loop, IC resection)
-Hypomotility: DM, Sclerdoerma, Narcotics
-partial obstruction
-decreased acid secretion
-colon fistula (crohns)
Signs
-diarrhea, statarhea, abd bloating, wt loss
complications
-fat soluble (A-night blindness Xerophthalmia, D-osteomalacia, E-hemolytic anemia, k- clotting dysfunction) and vit b12 defficincy, elevated folate
Dx- aspiration of duodenum with culture, glucose Hydrogen breath test, empiric tx with abx

Question 6

Describe the clinical presentation Pancreatic insufficiency

Answer 6

Chronic poancreatitis or severe CF can cause it
90% of pancrease is ruined,
first see lipid maldigestion

Question 7

Describe the clinical presentation Liver disease

Answer 7

Cirrhosis, biliary obstruction