dz of small bowel

Question 1

1. Know the tumors of the appendix.

Answer 1

carcinoid and epithelial. Benign: mucinous cystadenoma and villous adenoma. Malignant: adenocarcinoma and lymphoma.

Question 2

3. Describe the clinical presentation of fat malabsorption.

Answer 2

symptoms: Weight loss, diarrhea, steatorrhea, vitamin deficiencies. Plae, bulky malodorous stool which float, are difficult to flush and leave oily residue.

Question 3

Causes of malabsorption

Answer 3

surgery (gastric bypass can cause inadequate mixing of food with biliary/pancreatic secretions), bacteria, meds, pancreatic insufficiency, liver dz, intestinal inflammation/villus flattening, ulceration, ischemia, infiltrations (amyloidosis)

Question 4

gastric bypass vitamin deficiencies

Answer 4

•B12, Fe, Ca, Vit D deficiencies the most common

Question 5

4. Understand the presentation,of celiac disease.

Answer 5

abd distension, abd pain, anorexia, bulky sticky pale stools (steatorrhea), diarrhea, flatulences, failure to thrive, vomiting. Atypical: iron deficiency anemia, dermatitis herpetiformis, LFT elevations, cerebellar ataxia, osteoporosis

Question 6

celiac histology

Answer 6

•Loss of villi, crypt hyperplasia, IE Lymphocytes

Question 7

Celiac pathogenesis

Answer 7

Associated with autoimmune diseases, e. g. Thyroiditis, Type-I diabetes, Female:Male=2:1. HLA-DQ2, HLA-DQ8 (40% US): APC-MHC-II, present gluten peptides, 2-5% gene carriers develop disease.
CD4+ T cell response (IELs). All have antibodies to tissue transglutaminaseAssociated with autoimmune diseases, e. g. Thyroiditis, Type-I diabetes, Female:Male=2:1. HLA-DQ2, HLA-DQ8 (40% US): APC-MHC-II, present gluten peptides, 2-5% gene carriers develop disease.
CD4+ T cell response (IELs). All have antibodies to tissue transglutaminase

Question 8

celiac diagnosis

Answer 8

small intestine biopsy, serum anti-TTG, anti-endomysial Abs, anti-gliadin IgA and IgG.

Question 9

Understand the pathogenesis diagnosis and treatment of small bowel bacterial overgrowth.

Answer 9

Causes: anatomic abnormalities, hypomotility (diabetes), obstruction of intestines, decreased acid secretion. Signs: diarrhea, steatorrhea, abd pain, bloating, weight loss, fat soluble vit and B12 deficiency, nl to high folate. Diagnosis: aspiration of duodenum with culture, glucose hydrogen breath test. treatment: antibiotics

Question 10

outcomes of Fat soluble vitamin deficiencies

Answer 10

Vit A: night blindness, xerophthalmia. Vit D: osteomalacia. Vit E: hemolytic anemia. Vit K: clotting dysfunction

Question 11

tropical sprue

Answer 11

Residents or visitors to tropics. Cause: bacterial toxins or colonization of aerobic coliform bacteria. Classic presentation: Megaloblastic anemia from B12 and folate deficiency. Diagnosis: intestinal biopsy with villous flattening and travel history. Treatment: Antibiotics, B12, and folate

Question 12

Whipples disease

Answer 12

Caused by gram positive T. whippelii. Clinical Signs: fever, joint pain, diarrhea, abdominal pain, CNS-neurologic symptoms. PAS+ Macrophages on biopsy, PCR. Treatment: One year of antibiotics

Question 13

Mesenteric ischemia

Answer 13

Atherosclerosis, Clot, Radiation. Chronic: 2 of 3 major vessels occluded (post-prandial abdominal pain, weight loss, sitophobia, malabsorption). Acute: embolus (severe abdominal pain)

Question 14

malabsorption diagnostic tests

Answer 14

Focused testing-clinical scenario, Fecal Fat, Vitamin levels, CBC, albumin, CT-small bowel, liver, pancreas, bile ducts, Endoscopy

Question 15

two main causes of diarrhea

Answer 15

•Decreased absorption of fluid and electrolytes OR increased secretion of fluid and electrolytes

Question 16

2. Name four types of diarrhea based on stool characteristics and give examples of each type.

Answer 16

1. Fatty: malabsorption, maldigestion. 2. watery: osmotic (carb malabsorption, mg containing laxatives), secretory (cholera/e coli, neuroendocrine tumors). 3. inflammatory/exudative: infection, IBD, ischmia. 4. functional.

Question 17

osmotic vs secretory diarrhea

Answer 17

measure stool sodium and potassium.calculate stool osmotic gap: osmolarity - stool Na+K. If osmotic gap is >50, diarrhea is osmotic. If <50, diarrhea is secretory. Secretory diarrhea loses lots of electrolytes, osmotic doesn’t

Question 18

malabsorption vs maldigestion syndromes

Answer 18

malabsorption: celiacs, whipples, short bowel syndrome, small bowel bacterial overgrowth. Maldigestion: pancreatic insufficiency, liver dz

Question 19

Diagnosis of infectious diarrhea

Answer 19

fecal leukocytes- invasive organisms (shigella) produce PMN leukocytes, while toxigenic organisms (cholera) do not

Question 20

inflammatory diarrhea diagnosis

Answer 20

Infection: Usually Stool Culture, Endoscopy. Ischemia: CT scan, Endoscopy-colon. Inflammatory Bowel Disease: Endoscopy

Question 21

IBS symptoms

Answer 21

bdominal Pain and altered bowel habits in the absence of organic cause. Pain improved with defecation, Pain onset with change in stool frequency, Pain onset with change in stool appearance