diseases of the small intestine Flashcards
what are the two causes of small intestine ischaemia
mesenteric arterial occlusion
non-occlusive perfusion insufficiency
what are the causes of mesenteric arterial occlusion (2)
mesenteric artery atherosclerosis
thromboembolism from the heart
what are the causes of non-occlusive perfusion insufficiency
shock
strangulation from obstructing venous return (hernia, adhesion)
drugs (cocaine)
hyperviscosity
when does most of the damage in non-occlusive perfusion insufficiency ischaemia occur
during reperfusion
is ischaemia USUALLY acute or chronic
acute
how is acute ischaemia classified
by degree of infract:
mucosal to mural to trans,ural
what are the complications of ischaemia
resolution fibrosis stricture chronic ischaemia mesenteric angina obstruction gangrene perforation peritonitis sepsis death
what is Meckel’s diverticulum
it is the incomplete regression of the vital-intestinal duct.
tubuar structure 2 inches long, 2ft above the IC valve
how many people suffer from Meckel’s diverticulum
2%
what may Meckel’s diverticulum contain
heterotopic gastric mucosa
symptoms of Meckel’s diverticulum
asymptomatic (most common)
bleeding
perforation
diverticulitis which will mimic appendicitis
causes of appendicitis
unknown (most common) dehydration lymphoid hyperplasia parasites tumour (rare)
what does appendicitis involve
acute inflammation (neutrophils) which involves the muscle coat
mucosal ulceration
pus in the lumen
symptoms of appendicitis
vomiting
abdominal pain
RIF tenderness
increased WCC
complications of appendicitis
rupture peritonitis abscess fistula sepsis
which are more common: primary tumours or secondary
secondary
where do the secondary tumours metastasise from
ovary
colon
stomach
what are the 3 types of primary tumour
carcinoid tumours
carcinoma
lymphomas
what type of lymphomas are found in the small intestine
non-hodgkin’s lymphomas
what are lymphomas associated with
coeliac disease
what is the treatment of lymphomas
surgery
chemo
what is carcinoma associated with
crown’s disease
coeliac disease
how does carcinoma present and where does it metastasise to
late
metastases to lymph nodes and liver
describe the appearance of carcinoid tumours
small, yellow and slow growing
what is the most common site of carcinoid tumours
appendix
what can carcinoid tumours cause
intussusception
obstruction
produce hormone like substances
what happens if carcinoid tumours metastasise to the liver
carcinoid syndrome occurs producing flushing and diarrhoea
what are the symptoms of small intestine perforation
pain dependent on site of perforation
may occur with peritonism
what are the investigations of perforation
erect CXR (1st line) CT
investigations of appendicitis
Ultrasound (1st line)
iliopsoas test
PR exam
if the appendix has perforated due to appendicitis what would the pain be described as
pain is generalised with guarding die to peritoneum
what is intestinal fluid
an inability to maintain adequate nutrition or fluid status via the intestines
what are causes of intestinal fluid
obstruction dysmotility surgical resection congenital defect diseases associated with loss of absorption
how many types of intestinal failure is there
3
what types of intestinal failure fall under “acute/short term”
type 1 & 2
what is chronic/long term intestinal failure also known as
type 3
what is the treatment for type 1 intestinal failure
Replace fluid + correct electrolytes
Parenteral nutrition if unable to tolerate oral food/fluid >7 days
Acid suppression = PPI
Preserve Mg = alpha hydroxycholecalciferol
what is the treatment for type 2 intestinal failure
mostly parenteral feeding +/- enteral feeding
what diseases causes type 2 intestinal failure
sepsis
abdominal surgery complications
metabolic complications
what is the treatment for type 3 intestinal failure
home parenteral nutrition (preferred treatment) intestinal transplant GLP2 treat meant if its caused by short bowel syndrome bowel lengthening (KIDS ONLY)
what diseases cause type 3 intestinal failure
- Short gut syndrome
- Crohn’s disease
- Neoplasia
- Vascular
- Mechanical
- Radiation enteritis
- Dysmotility
what is short bowel syndrome
> 200cm of bowel
length is insufficient to meet nutritional needs
treatment of short bowel syndrome
HPN bowel lengthening (children only)
