diseases of the small intestine

Question 1

what are the two causes of small intestine ischaemia

Answer 1

mesenteric arterial occlusion

non-occlusive perfusion insufficiency

Question 2

what are the causes of mesenteric arterial occlusion (2)

Answer 2

mesenteric artery atherosclerosis

thromboembolism from the heart

Question 3

what are the causes of non-occlusive perfusion insufficiency

Answer 3

shock
strangulation from obstructing venous return (hernia, adhesion)
drugs (cocaine)
hyperviscosity

Question 4

when does most of the damage in non-occlusive perfusion insufficiency ischaemia occur

Answer 4

during reperfusion

Question 5

is ischaemia USUALLY acute or chronic

Answer 5

acute

Question 6

how is acute ischaemia classified

Answer 6

by degree of infract:

mucosal to mural to trans,ural

Question 7

what are the complications of ischaemia

Answer 7

resolution 
fibrosis
stricture
chronic ischaemia 
mesenteric angina
obstruction 
gangrene
perforation
peritonitis
sepsis
death

Question 8

what is Meckel’s diverticulum

Answer 8

it is the incomplete regression of the vital-intestinal duct.

tubuar structure 2 inches long, 2ft above the IC valve

Question 9

how many people suffer from Meckel’s diverticulum

Answer 9

2%

Question 10

what may Meckel’s diverticulum contain

Answer 10

heterotopic gastric mucosa

Question 11

symptoms of Meckel’s diverticulum

Answer 11

asymptomatic (most common)
bleeding
perforation
diverticulitis which will mimic appendicitis

Question 12

causes of appendicitis

Answer 12

unknown (most common)
dehydration
lymphoid hyperplasia
parasites
tumour (rare)

Question 13

what does appendicitis involve

Answer 13

acute inflammation (neutrophils) which involves the muscle coat
mucosal ulceration
pus in the lumen

Question 14

symptoms of appendicitis

Answer 14

vomiting
abdominal pain
RIF tenderness
increased WCC

Question 15

complications of appendicitis

Answer 15

rupture
peritonitis 
abscess
fistula 
sepsis

Question 16

which are more common: primary tumours or secondary

Answer 16

secondary

Question 17

where do the secondary tumours metastasise from

Answer 17

ovary
colon
stomach

Question 18

what are the 3 types of primary tumour

Answer 18

carcinoid tumours
carcinoma
lymphomas

Question 19

what type of lymphomas are found in the small intestine

Answer 19

non-hodgkin’s lymphomas

Question 20

what are lymphomas associated with

Answer 20

coeliac disease

Question 21

what is the treatment of lymphomas

Answer 21

surgery

chemo

Question 22

what is carcinoma associated with

Answer 22

crown’s disease

coeliac disease

Question 23

how does carcinoma present and where does it metastasise to

Answer 23

late

metastases to lymph nodes and liver

Question 24

describe the appearance of carcinoid tumours

Answer 24

small, yellow and slow growing

Question 25

what is the most common site of carcinoid tumours

Answer 25

appendix

Question 26

what can carcinoid tumours cause

Answer 26

intussusception obstruction produce hormone like substances

Question 27

what happens if carcinoid tumours metastasise to the liver

Answer 27

carcinoid syndrome occurs producing flushing and diarrhoea

Question 28

what are the symptoms of small intestine perforation

Answer 28

pain dependent on site of perforation | may occur with peritonism

Question 29

what are the investigations of perforation

Answer 29

``` erect CXR (1st line) CT ```

Question 30

investigations of appendicitis

Answer 30

Ultrasound (1st line) iliopsoas test PR exam

Question 31

if the appendix has perforated due to appendicitis what would the pain be described as

Answer 31

pain is generalised with guarding die to peritoneum

Question 32

what is intestinal fluid

Answer 32

an inability to maintain adequate nutrition or fluid status via the intestines

Question 33

what are causes of intestinal fluid

Answer 33

``` obstruction dysmotility surgical resection congenital defect diseases associated with loss of absorption ```

Question 34

how many types of intestinal failure is there

Answer 34

3

Question 35

what types of intestinal failure fall under "acute/short term"

Answer 35

type 1 & 2

Question 36

what is chronic/long term intestinal failure also known as

Answer 36

type 3

Question 37

what is the treatment for type 1 intestinal failure

Answer 37

Replace fluid + correct electrolytes Parenteral nutrition if unable to tolerate oral food/fluid >7 days Acid suppression = PPI Preserve Mg = alpha hydroxycholecalciferol

Question 38

what is the treatment for type 2 intestinal failure

Answer 38

mostly parenteral feeding +/- enteral feeding

Question 39

what diseases causes type 2 intestinal failure

Answer 39

sepsis abdominal surgery complications metabolic complications

Question 40

what is the treatment for type 3 intestinal failure

Answer 40

``` home parenteral nutrition (preferred treatment) intestinal transplant GLP2 treat meant if its caused by short bowel syndrome bowel lengthening (KIDS ONLY) ```

Question 41

what diseases cause type 3 intestinal failure

Answer 41

* Short gut syndrome * Crohn’s disease * Neoplasia * Vascular * Mechanical * Radiation enteritis * Dysmotility

Question 42

what is short bowel syndrome

Answer 42

>200cm of bowel length is insufficient to meet nutritional needs

Question 43

treatment of short bowel syndrome

Answer 43

``` HPN bowel lengthening (children only) ```