Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastroenterology > Disorders of the Small Intestines and Colon > Flashcards

Disorders of the Small Intestines and Colon Flashcards

1
Q

Normal digestion and absorption has 3 phases. What are they?

A

Intraluminal phase
Mucosal phase
Absorptive phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Classified as a disruption of digestion and/or nutrient absorption

A

Malabsorption Disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Immune disorder caused by exposure to gliadin; abnormal immune
response to gluten

Loss of absorptive surface results in malabsorption

Antigenic stimulus from gluten causes formation of IgA antibodies directed against gliadin and tissue transglutaminase

More common in females (2:1)

Can present in infancy, but commonly ages 40-50

History of European ancestry

Often mistaken for IBS in adults

Also often mistaken for lactose intolerance

A

Celiac Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Consider what disease in any patient presenting with unexplained
deficiencies of iron, folate, Vitamin B12, non-specific GI complaints

A

celiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What characteristic skin rash suggests Celiac Sprue?

A

Dermatitis herpetaformis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is celiac disease diagnosed?

A

IgA endomysial ab, IgA tissue transglutaminase

Small bowel biopsy (confirmatory)

Clinical improvement on gluten-free diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Congenital deficiency or absence of enzymes that border the lining of the stomach (lactase)

Appears in childhood and adulthood: Age of onset – typically age 6

A

Lactase Deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Brush border enzyme, produced in the small intestines

Hydrolyzes lactose to glucose and galactose

A

Lactase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is lactase deficiency diagnosed?

A

Lactose breast test

Lactose load test

Empirical trial of lactose elimination x 2 weeks

Refer to GI for confirmation: Hydrogen breath test, Stool acidity test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Literal dumping of stomach contents into proximal small intestine

Malabsorption due to surgery

Gastric emptying of liquids is more rapid – dilution of pancreatic
enzymes and bile acid in duodenum leads to mismatch of chyme
delivery and absorptive capacity

Decrease in pepsin secretion leads to bacterial overgrowth

A

Dumping Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

There are minimal number of bacteria in small intestine

An overgrowth of the bacteria leads to malabsorption

Bacterial deconjugation of bile salts

A

Bacterial Overgrowth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causative agent Tropheryma whippeli

Source unknown

Common in white men ages 40-60s

Fatal if not treated

A

Whipple Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the causative agent in Whipple Disease?

A

Tropheryma whippeli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is Whipple disease diagnosed?

A

Duodenal biopsy - reveals infiltration of lamina propria with periodi acid-Schiff positive macrophages containing gram-positive bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the treatment and monitoring for Whipple disease?

A

antibiotics - Ceftriaxone 1g IV BID or Meropenem 1g IV TID x 2 weeks followed by Bactrim DS BID x 12 months

Duodenal biopsy along with CSF PCR should be done every 6 months for at least a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most common causes of acute abdomen and abdominal surgical
emergency (most common operation in the US)

Peak incidence >20 years old

Should be considered in anyone with acute abdominal pain

A

Appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the cause of appendicitis?

A

Caused by obstruction of the appendix by:
Fecalith/appendicolith
Infectious process
Foreign body (calculi)
Parasitic worms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are we concerned about with appendicitis?

A

Inflammation of the veriform appendix leads to necrosis and abscess
formation, and eventually peritonitis

Gangrene and perforation develop within 36 hours if untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common cause of appendicitis in children?

A

Hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common cause of appendicitis in adults?

A

Fecalith

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In appendicitis, what is the most common symptom and first to appear?

A

Anorexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which sign is described below that helps to diagnose appendicitis?

Pain on extension of right hip

A

+Psoas sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which sign is described below that helps to diagnose appendicitis?

Pain with internal rotation of right hip

A

+obturator sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which sign is described below that helps to diagnose appendicitis?

Pain in RLQ elicited with palpation of LLQ

A

+ Rovsing’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What imaging is the gold standard for appendicitis?

A

CT – gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the mortality rate for appendicitis?

A

Mortality <1% overall

Mortality can be as high as 20% in elderly patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is typically the cause of mortality in appendicitis cases?

A

Mortality comes from the complications, rare the actual appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Neurogenic failure or loss of peristalsis in the intestine without
mechanical obstruction

A

Acute Paralytic Ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some causes of acute paralytic ileus?

A

Post-surgical
Respiratory failure requiring intubation
Sepsis
Severe infections
DKA
Electrolyte disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are some methods to diagnose acute paralytic ileus?

A

Plain abdominal xray: Gas-filled loops of small and large bowel

Air-fluid levels

Abdominal CT scan

Serum electrolytes

Note: may be difficult to distinguish ileus from partial small bowel obstruction on xray alone, need history and physical as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the treatment for acute paralytic ileus?

A

Treat underlying cause

IV fluids 🡪 NPO

NG tube - Low suction, typically will resolve in several days

Avoid opioids and anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are some causes of small bowel obstructions?

A

Adhesions s/p surgery (most common)
Hernia
Intussuseption
Lymphoma
stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the most common cause of small bowel obstructions?

A

Adhesions s/p surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What xray finding would you see in a case of a small bowel obstruction?

A

Upright shows multiple air fluid levels and “step ladder” or “stack of coins” appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the treatment for small bowel obstruction?

A

True mechanical obstructions require surgery

In ED, attempt to remove excess air and bowel contents with nasogastric tube

IV fluid replacement and bowel rest

All require broad spectrum antibiotics prior to intervention - worry about perforation and contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Pouch in the wall of the lower part of the bowel

Most common congenital GI tract abnormality

Males = females

Complications more likely in males (50% of complications occur by age 2)

A

Meckel’s Diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are some signs/symptoms of Meckel’s Diverticulum?

A

Bleeding (hematochezia) - painless

Intestinal obstruction

Intestinal volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What testing is used to diagnose Meckel’s Diverticulum?

A

Technitium scan - Radio-opaque dye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Telescoping or invagination of a proximal portion of the bowel into a distal portion

Peristalsis acts to pull in more bowel, leading to constriction and edema

Hemorrhage may occur

Most commonly in the 3-12 month olds

A

Intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Most frequent cause of intestinal obstruction in the infant

A

Intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are some signs/symptoms of Intussusception?

A

Currant jelly stools – 50% (Bloodly bowel movements with mucous
appear)

Severe, colicky pain

Tender, distended abdomen

Sausage-like abdominal mass in upper mid abdomen

Kids look sick, failure to thrive appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What percentage of adenocarcinomas are metastasized at the time of diagnosis?

A

80% are metastasized at the time of diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is used to diagnose Intussusception and what would you expect to see?

A

Abdominal ultrasound - Target sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are some risk factors for Adenocarcinoma?

A

History of colorectal cancer
Hereditary nonpolyposis colorectal cancer
Peutz-jeghers syndrome
Familial adenomatous polyposis
Crohns disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are some risk factors/causes of Intussusception?

A

Meckel diverticulum

Intestinal polyps

Lymphomas

Cystic fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

This tumor of the small intestine is aggressive and most commonly occurs in duodenum

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How is small bowel adenocarcinoma diagnosed?

A

Can be seen with UGI with small bowel follow through

CT scan

Capsule endoscopy

Diagnosis confirmed by biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the treatment for small bowel adenocarcinoma?

A

Surgical resection of early lesions cure 40%

Resection is also recommended for control of symptoms

Chemo may be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Primary or secondary to disseminated disease

Most common site: Stomach and small intestines

A

Lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the most common type of lymphoma to disseminate to the stomach and small intestines?

A

Non-Hodgkins B cell lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the treatment for lymphoma of the small bowel?

A

Surgical resection

Surgical debulking

Chemo +/- radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

A type of neuroendocrine tumor

Most frequent in the small intestines (ileum)

5 year survival rate is 50%

Usually found incidentally

Invasive growth or distant metastasis best indicator of prognosis

A

Carcinoid Tumors

48
Q

What is the treatment for carcinoid tumors?

A

If confined to the small intestine – local excision (85% cure rate)

Palliative treatment for late disease

49
Q

What are the signs/symptoms of carcinoid tumors?

A

Carcinoid syndrome (tumors secrete serotonin):
Flushing
Diarrhea
Hypotension

50
Q

Most common cause of lower GI bleed

A

Diverticulosis

51
Q

Saccular outpouchings of the colon – bulge at point of weakness from pressure

Commonly sigmoid and descending colon

Among the most common diseases in the US

A

Diverticulosis

52
Q

What location is diverticulosis most common and why?

A

More common in sigmoid colon where intraluminal pressures are greatest

53
Q

What is the etiology of diverticulosis?

A

Results from pressure that is exerted on the intestinal wall, leads to a bulge at a point of weakness, usually near to where an artery penetrates the muscular layer

May be associated with fiber-poor diets and people with connective tissue disorders

54
Q

What is a complication of diverticulosis?

A

Diverticular hemorrhage develops in 5-15% of patients with diverticulosis

Diverticulitis

55
Q

Inflammation of one or more diverticula

Occurs in 15-20% of patients with diverticulosis

A

Diverticulitis

56
Q

What is the etiology of diverticulitis?

A

Fecalith or nuts/seeds in food: theory – feces/seed goes into pouch, sits and becomes infected

high intraluminal pressure 🡪 can lead to rupture or infection

57
Q

What are some complications of diverticulitis?

A

Abscess
Perforation
Peritonitis
Intestinal obstruction
Fistula
Chronic stricture

58
Q

What is the treatment for diverticulitis?

A

Most require hospitalization, especially elderly

Clear liquid diet (bowel rest), slow advance of bland diet

IV fluids – rehydration

Antibiotics: Cipro BID & Flagyl TID for 7 to 10 days – gold standard

Pain control

Surgical resection of the infected area

59
Q

Antibiotic associated diarrhea – current or prior use within 3 months

Significant clinic problem almost always caused by C. difficile

Hospitalized patients and those in chronic care facilities are the most susceptible

Transmitted easily from patient to patient by hospital personnel

Toxin-mediated disease

A

Pseudomembranous Colitis

60
Q

What are some causative antibiotics for Pseudomembranous Colitis?

A

Aminopenicillins

Clindaymycin

Cephalosporins (2nd and 3rd generation)

Fluroquinolones

61
Q

What is the treatment for Pseudomembranous Colitis?

A

d/c broad spectrum antibiotic therapy - Diarrhea will resolve in 15-20% of patients

Drug of choice – Flagyl (500mg PO TID x 14 days)

Vancomycin – severe disease (Severe = WBC >15000, Cr >1.5 times
baseline)

Avoid antimotility agents and narcotics (May delay the clearance of the toxins)

+/- enema if underlying ileus, megacolon, or shock

62
Q

Approximately what percentage of pseudomembranous colitis patients
relapse?

A

Approximately 20% of patients

63
Q

What is the reason/cause for the pseudomembranous colitis patients
relapse?

A

Recurrence is from germination of spores persisting in the colon or
reinfection

64
Q

Why is PO Vancyomycin used in pseudomembranous colitis instead of IV Vancyomycin?

A

IV vancomycin does NOT penetrate the bowel

65
Q

Idiopathic, chronic inflammatory disease

Diffuse mucosal inflammation

Involves the rectum

May extend proximally in a continuous fashion to involve part or all of the colon

A

Ulcerative Colitis

66
Q

Describe the peak incidence of ulcerative colitis?

A

Bimodal incidence: first peak 20-30 year olds, second peak 50-70 year
olds

Most commonly diagnosed in late adolescence and early adulthood

Mean age: 43-55 year old

67
Q

Disease is less severe in UC patients who also do what?

A

Smoking protects against UC

Disease less severe in smokers

68
Q

What is the pathophysiology of ulcerative colitis?

A

Inflammation begins in the distal rectum and spread proximally –
continuous lesion

Crypt architecture is distorted

Mucosal vascular congestion with edema and focal hemorrhage may
be present

Neutrophils invade the epithelium, usually in crypts 🡪 cryptitis and
ultimately, crypt abscess

Results in a diffuse friability and erosions with bleeding

69
Q

In ulcerative colitis, what is always involved?

A

the rectum

70
Q

What is the hallmark finding of ulcerative colitis?

A

Bloody diarrhea with mucous – HALLMARK finding

71
Q

What is the key to diagnosing ulcerative colitis?

A

Colonoscopy – key to diagnosis

72
Q

What is the mainstay of medical management of ulcerative colitis?

A

Sulfasalazine – mainstay of Rx

Antibacterial and anti-inflammatory therapy

73
Q

In patients taking Sulfasalazine, what supplement is needed?

A

Impairs folate absorption – need folate replacement

74
Q

Which medication is added on to Sulfasalazine in moderate to severe cases of ulcerative colitis?

A

Glucocorticoids

75
Q

In ulcerative colitis patients, approximately what percentage will have surgery within 10 years of diagnosis?

A

50%

76
Q

What is the surgery of choice in ulcerative colitis?

A

Operation of choice - Single stage total proctocolectomy with ileostomy

77
Q

Why is surgical management used in treating ulcerative colitis?

A

Surgery is CURATIVE

78
Q

What are some complications of ulcerative colitis?

A

Toxic megacolon <2% (50% mortality)

Perforation

Cancer (34% risk of colon cancer after 30 years of disease)

79
Q

Extreme dilation and immobility of the colon

Surgical emergency

A

Toxic Megacolon

80
Q

What is the mortality rate of a toxic megacolon?

A

Mortality rates of 15-50%

81
Q

What other conditions is toxic megacolon associated with?

A

Associated with ulcerative colitis (may be the presenting sx of UC,
usually presents early in the disease)

Crohns disease

Amoebic colitis

Pseudomembranous colitis

Infections (shigella, C. diff, Clostridium)

82
Q

What is the treatment for toxic megacolon?

A

Emergent surgery (resection)

Initial therapy is medical, patients at risk for perforation

IV fluids

Colon decompression

83
Q

Also called Acute Colonic Pseudo-obstruction or acute megacolon

Type of megacolon

Significant cecal dilatation

At risk for spontaneous perforation

Post-surgical or medical patients who are severely ill or have malignancy

Must rule out ischemia or obstruction

A

Ogilvie Syndrome

84
Q

Sudden, twisting of the bowel on itself leading to obstruction and ischemia

Small bowel twists around the superior mesenteric artery, leads to kinking of the duodenum –> Results in reduced blood supply to the midgut 🡪 ischemia and necrosis of the bowel

Gangrene, necrosis, and perforation can occur

Increased incidence in elderly and patients with other comorbidities

A

Volvulus

85
Q

What are the two most common sites for Volvulus?

A

Cecum

Sigmoid colon

86
Q

What percentage of cases of Volvulus present less than one month of age?

A

> 50% present less than one month of age

87
Q

What are some causes of volvulus?

A

Idiopathic
Anomaly of rotation
ingested foreign body
Adhesions

88
Q

If you see a “double bubble” sign on an Xray, what should you suspect?

A

Volvulus

89
Q

What is the treatment for a volvulus?

A

Endoscopic reduction if stable

Surgical repair: If patient has peritonitis – exploratory laparotomy and
resection with diverting colostomy

90
Q

Congenital absence of autonomic smooth muscle ganglia

Aganglionic bowel segment contracts but needed relaxation does not occur which leads to stasis of stool and constipation

A

Hirschsprung Disease

91
Q

In Hirschsprung Disease, what location is most commonly affected?

A

90% occur in rectosigmoid area

Can affect the entire colon

92
Q

Most common cause of lower GI obstruction in neonates (blockage due to improper nerve impulses to muscle movement)

A

Hirschsprung Disease

93
Q

Hirschsprung Disease coexists with what other anomalies?

A

Down Syndrome

94
Q

What is the typical initial presentation of Hirschsprung Disease?

A

No first bowel movement (meconium) within 24-48 hours of birth

Stool: small, ribbon-like

Appearance: chronically ill

Anal tone: tight

Rectum: empty

Soiling: rare

95
Q

What is the gold standard for diagnosing Hirschsprung Disease?

A

Rectal biopsy

96
Q

What is the treatment for Hirschsprung Disease?

A

Mild - fiber

More severe - May involve 1 or 2 surgeries

97
Q

A chronic, recurrent disease; lifelong illness

Patchy, transmural inflammation (skip lesions) involving any segment of the GI tract from
mouth to anus

Incidence: 5 per 100,000 in the US

In 10% of cases, it may be impossible to distinguish from UC – much overlap exists

A

Crohn’s Disease

98
Q

What is the incidence of Crohn’s Disease?

A

Bimodal incidence: first peak 20-30 year olds, second peak 50-70 year olds

Most commonly diagnosed in late adolescence and early adulthood

Mean age: 33-45 year old

99
Q

What can exacerbate Crohn’s Disease?

A

Cigarette smoking increases the risk of Crohns

NSAIDs exacerbate

100
Q

What is the involvement of Crohn’s Disease?

A

Can involve anywhere along the entire GI tract (mouth to anus)

Rectum is often spared

Involvement with UGI tract is rare

101
Q

What is the pathophysiology of Crohn’s Disease?

A

Initial lesions are aphthoid ulcers and focal crypt abscess – stellate ulcerations fuse longitudinally and transversely, demarcating normal islands of mucosa

Form noncaseating granulomas from mucosa to serosa

Submucosal or subseroal lymphoid aggregates

Transmural inflammation is accompanied by fissures – may form fistulous tracts or abscesses

“skip lesions”

102
Q

What are some extraintestinal complications of Crohn’s Disease?

A

Oral aphthous ulcers (earliest manifestation)

Increased prevalence of gallstones due to malabsorption of bile salts from the terminal ileum

Acute arthropathy

Ocular manifestations (uveitis)

Nephrolithiasis

Erythema nodosum

Pyoderma gangrenosum

103
Q

Uncommon inflammatory ulcerative skin disease

Affects less than 10% of IBD patients

Occurs more often with UC than Crohns

Seriousness of skin ulcer does not correlation to seriousness of IBD

A

Pyoderma Gangrenosum

104
Q

A classic skin condition associated with Crohns

Presents as tender red nodules (usually on the shins)

Causes fever and joint pain

Usually resolves in 3-6 weeks

A

Erythema Nodosum

105
Q

What two labs can help differentiate between Crohns and UC?

A

Antisaccharomyces cerevisiae antibodies (ASCA) and antineutrophil cytoplasmic antibodies (pANCA)

ANCA +: freq in UC, rare in Crohns

ASCA +: rare in UC and freq in Crohns

*must be interpreted with clinical findings and other diagnostic results

106
Q

What is the gold standard for diagnosing Crohns disease?

A

Colonoscopy – gold standard for diagnosis

107
Q

What are some complications of Crohns disease?

A

Abscess – 20%
Strictures
Intestinal narrowing
Fistulas – 40%
Malabsorption
Perianal disease
Increased risk for developing colorectal carcinoma – small bowel adenocarcinoma

108
Q

What is the medical mainstay of treatment for Crohns disease?

A

Sulfasalazine – mainstay of Rx

Antibacterial and anti-inflammatory therapy

109
Q

What are the surgical management guidelines for Crohns disease?

A

Surgery is not CURATIVE - You cannot resect all of the bowel since it is mouth to anus

With small bowel disease, resect as little intestine as possible

Will need surgery for intractability, fulminant or anorectal disease

110
Q

If more than 50cm of what is resected, patient needs monthly B12
injections

A

ileum

111
Q

Condition that is secondary to removal of small intestines:

Crohns resection
Mesenteric infarct
Tumor resection

A

Short Bowel Syndrome

112
Q

Chronic (>6months) functional bowel disorder

Symptoms are not explained by structural or biochemical abnormalities

Recurrent abdominal pain, alterations in bowel habits

Associated with history of depression/anxiety – 50%

A

Irritable Bowel Syndrome

113
Q

Definition: abdominal pain/discomfort with two of the three features:

Relieved with defecation
Onset associated with change in frequency of stool
Onset associated with change in form of stool

A

Irritable Bowel Syndrome

114
Q

What are some causes of Irritable Bowel Syndrome?

A

Evidence shows physiologic disturbances occur in the majority
of patients - Abnormal visceral perception or extraintestinal motor dysfunction

Bacterial overgrowth

Psychological

Diet

Infection

115
Q

In potential cases of irritable bowel syndrome, the presence of these symptoms suggest other diagnoses

A

Acute onset
>40 years of age
Severe constipation or diarrhea
Nocturnal diarrhea (never normal)
Hematochezia
Weight loss
Fevers
Family history of cancer, inflammatory bowel disease, celiac disease

116
Q

What are the three main branches of abdominal aorta?

A

celiac artery
superior mesenteric artery
inferior mesenteric artery

117
Q

Injury ranges from reversible to transmural bowel necrosis

Persistent vasoconstriction causes progression of ischemic injury despite relief measures if not corrected quickly

A

Intestinal ischemia

118
Q

Abdominal pain mostly postprandial

Weight loss secondary to above

Results from occlusion of major mesenteric vessel or non-occlusive disease

Usually 2-3 visceral vessels affected before symptoms develop

A

Visceral artery insufficiency (“intestinal angina)

119
Q

What are the types of ischemic bowel disease?

A

Colon ischemia (60%)

Acute mesenteric ischemia (30%)

Focal segment ischemia (5%)

Chronic mesenteric ischemia (5%)

120
Q

Which type of ischemic bowel disease is described below?

Mainly occurs in IMA distribution

Secondary to reduction in blood flow

Can happen post-op

Non-occlusive

Colonic mucosa will slough secondary to under-perfusion

Abdominal cramping followed by rectal bleed

A

Ischemic Colitis

121
Q

Which type of ischemic bowel disease is described below?

Challenging diagnosis

Hypo-perfusion of bowel vasculature

Increasing incidence in western countries parallels atherosclerosis and aging population

> 50 year olds

Think of mesenteric ischemia if an elderly patient presents with an acute abdomen

A high index of suspicion is vital to detect them earlier and minimize morbidity and mortality

A

Acute Mesenteric Ischemia

122
Q

What are some risk factors for acute mesenteric ischemia?

A

Atrial fibrillation
History of MI
Valvular heart disease
Peripheral artery disease

123
Q

Abdominal pain out of proportion to PE findings – sudden and severe
onset should raise your suspicion for what?

A

acute mesenteric ischemia

124
Q

What is the prognosis for acute mesenteric ischemia?

A

10-15% mortality and morbidity rate from surgical intervention

Without intervention, acute and chronic intestinal ischemia are fatal

Gastroenterology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions