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Exam 3 > Diseases Of The Small Bowel > Flashcards

Diseases Of The Small Bowel Flashcards

1
Q

Small bowel common symptoms

A

Diarrhea (post prandial, nocturnal, malabsorption, weight loss)
Abdominal pain (periumbilical)
Obstruction (pain, feculent vomiuts)
Bleeding

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2
Q

Causes of toxin mediated diarrhea

A

S aureus, v cholera, ETEC, EHEC, C. Perfingens, B . Cerrus

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3
Q

Causes of maldigestive diarrhea

A

Pancreatitis not producing enzymes
Post bilroth
Lack of stomach acid or intrinsic factor

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4
Q

Causes of malabsorption diarrhea

A

Lactose intolerance

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5
Q

Cause of steatorrhea

A

Pancreatic insufficiency, bile salt deficiency, impaired absorption all around (Short gut
Bacterial overgrowth)

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6
Q

Dietary factors that can cause diarrhea

A

Sugar free candy, high fructose corn syrup, lactose

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7
Q

Causes of osmotic diarrhea

A

Medications: Mg supplements, osmotic laxative abuse

Carbohydrate malabsorption: lactose, high fructose corn syrup, sugar alcohols

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8
Q

Causes of inflammatory diarrhea

A 
IBD
Celiac
Infection
 Ischemia
Radiation side effect
Lymphoma
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9
Q

Lab tests for fat in stool

A

Fecal fat/ fecal elastase

Low elastase means it could be pancreatitis

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10
Q

Lab test for fecal WBCs

A

Fecal calprotectin or lactoferrin

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11
Q

Lab tests for fat soluble vitamins

A

Carotene- A
Vitamin D panel- D
PT/INR- K

No test for E

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12
Q

Why would we test albumin or total protein?

A

Make sure youre not losing it in stool

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13
Q

low B12 means what part of intestine is not working?

A

Ileum

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14
Q

If ferritin is over ________, then it is likely to be iron deficiency anemia.

A

100

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15
Q

RBC folic acid is better because it tells you what?

A

Tells you about the long term folate absorption

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16
Q

Serum TTG tests what?

A

Celiac

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17
Q

Radiology studies for small intestine

A

Small bowel series
Enteroclysis- NG tube contrast
CT enterography- special contrast for distension wall vs. lumen

18
Q

Endoscopic imaging of the small bowel

A

Push enteroscopy- passes ligament of treitz, up to proximal jejunum

Capsule endoscopy- swallow it and walk around

Double balloon enteroscopy- mouth to anus creep along

Spirus enteroscopy- screws along

19
Q

Congenital malformations of small bowel

A

Meckels diverticulum

Malrotation of intestinal sides

20
Q

What is meckels diverticulum?

A

Congenital anomaly of the small intestine,
Incomplete obliteration of the vitteline duct leading to diverticulum in distal ileum
May need to be removed

21
Q

What is angioectasia?

A

Dilated vessel in the SI that may bleed
Bleeding vessel needs to be cauterized

Bad case= hereditary hemorrhagic telangiectasia

22
Q

Management of short gut

A

Continuous enteral feeding
Elemental feeds for easy absorption and less fluid loss
Complex feeds for adaption

23
Q

What does loss of ileocecal valve lead to?

A

Loss of mechanical slowing

Loss of ileal breaks when you eat a fatty meal

24
Q

Where do angioectasias localize?

A

Proximally in the small bowel

25
Q

Autoimmune diseases of the small bowel

A 
Celiac disease
Crohns 
Autoimmune enteritis
Eosinophilic gastroenteritisi
GVHD
Vasculitis
26
Q

Celiac MHA affected

A

HLA-DQ2 or HLA DQ8 immune disorder

27
Q

Celiac disease is triggered by what component of gluten from wheat?

A

Gliadin

TTG cross links glutamine rich proteins like gluten

28
Q

How do you make the diagnosis of celiac?

A

While on a gluten diet, test IgA anti-TTG or do a mucosal biopsy

29
Q

Diseases associated with celiac disease

A

Dermatitis herpetiformis, IgA deficiency, liver disease, down syndrome, AI thyroid disease, DM1, infertility, atrophic glossitis, cardiomyopathy, pancreatitis

30
Q

Celiac disease puts a patient at an increased risk of

A

Small bowel lymphoma and small bowel adenocarcinoma

31
Q

Common presentation of celiac disease

A 
Diarrhea
Steatorrhea
Weight loss
Malabsorption
Iron deficiency
Bloating
Vinous atrophy

Resolves with gluten free

32
Q

Villous atrophy of celiac disease means

A

Poor absorption

33
Q

Guy with drainage from his left flank every time he eats

A

Crohn’s enteric skin fistula

Jejunum drains out of back

34
Q

Crohn’s presentation

A 
Abdominal pain
Diarrhea
Fistulae
Obstruction
Peri-anal disease
Malabsorption
Weight loss
35
Q

What kind of inflammation is seen in crohn’s? What do they lead to?

A

Transmural inflammation leading to fibrosis, miroperforations and fistulae

36
Q

Extra-intestinal manifestations of crohns

A

Eye, erythema nodosum, pyoderma gangrenosum, arthritis, PSC, thromboemboli

37
Q

Celiac disease spares what?

A

The ileum, so B12 should be normal

38
Q

In what situation would there be an elevated serum folic acid but low normal serum b12?

A

Bacteria

They produce folic acid and compete with B12

39
Q

When does D-xylose breath test peak?

A

When food is in colon not in duodenum

40
Q

Jejunal aspirate is the gold standard for what?

A

Small bowel bacterial overgrowth

41
Q

Lady with multiple hemartomatous polyps

A

Peutz-Jegher Syndrome

42
Q

Diarrhea differential types

A

Osmotic most common
Inflammatory
Secretory
Fat malabsorption

Exam 3 (18 decks)

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