disorder of small and large intestine

Question 1

secretory diarrhea

Answer 1

isotonoic stool, persists during fasting

Question 2

osmotic diarrhea

Answer 2

osmotic forces exerted by unabsorbed luminal solutes and condition abates with fasting

Question 3

malabsorptive diarrhea

Answer 3

inadequate nutrient absorption is associated with stetaorrhea and is relieved by fasting

Question 4

exudative diarrhea

Answer 4

inflammatory disease and characterized by purulent bloody stools that cont during fastin

Question 5

infectious diarrhea

Answer 5

c diff - reduced number of normal bacteria d/t abx therapy (treat with flagyl, vanc, fecal transplant)
e coli - travelers diarrhea
enteric fever

Question 6

chron’s - IBD

Answer 6

ileum and colon, and sometimes rectal
areas of inflammation
transmural
fat/vitamin malabsorption
recurrence common

gene associated with excessive CD4 and T helper cells in response to gut bacteria

Question 7

ulcerative colitis - IBD

Answer 7

colon only, always rectal
diffuse inflammation
limited to mucosa and submucosa
toxic megacolon
surgery curative

Question 8

celiac disease

Answer 8

gluten immune reaction, inflammatory disorder of small intestine

genetic predisposition - pt develops antigens to gluten derived peptides, T cell response produces cytokines that damage epithelium in GI tract

biopsy will show - increased numbers of intraepithelial T lymphocytes, villus atrophy, hyperplasia of crypts, increased number of plasma cells, mast cells, eosinophils, detection of antibodies to transglutaminase and gliadin

Question 9

celiacs - peds

Answer 9

manifest with irritability, abd distention, anorexia, diarrhea, failure to thrive, weight loss, muscle wasting

may develop consequences of malabsorption - anemia, vitamin deficiency, stunted growth

Question 10

adult celiacs

Answer 10

commonly present between 30-60yo

bulky foul smelling stool, abd bloating, iron deficiency anemia

Question 11

intestinal obstruction causes

Answer 11

adhesions (most common)
tumors
herniation
volvulus
intussusception (telescoping of bowel through distal portion)

Question 12

necrotizing entercolitis

Answer 12

illness found most often in low birth weight infants with mortality up to 50%
short bowel syndrome, sepsis, adhesions
cause is uncertain - results in intestinal mucosal injury secondary to ischemia and ulceration of bowel

early signs - distention, bloody diarrhea, temp instability, lethargy

medically managed in NICU - bowel perf and free air in abd is usual indication for emergency surgery for resection of dead bowel

Question 13

NEC presentation

Answer 13

infants generally present with metabolic and hematologic abnorms
- hyperkalemia, hyponatremia, met acidosis, unstable glucose, coagulopathy/DIC, anemia

Question 14

surgical management of NEC

Answer 14

surgical emerency
intestine can no longer hold waste so bacteria may pass into bloodstream and lead to life-threatening sepsis

involves periotoneal drainage or laparotomy with resection of necrotic bowel

Question 15

anesthetic management of NEC

Answer 15

aspiration risk = RSI/awake intubation
inhalation agents poorly tolerated - use narcotic technique wiht muscle relaxation for HD stability
avoid nitrous
vasopressors for renal perfusion
large fluid and blood loss - resuscitate!!
transfusion in neonates is per kg 
- 10-15ml/kg PRBC and FFP
- EBV in neonates is 90-100 mL/kg
correct lytes and glucose