EXAM #1: SMALL BOWEL PATHOLOGY II

Question 1

What is diverticulosis?

Answer 1

Outpouching of the intestinal wall (mucosa and submucosa through the muscularis propria)

Question 2

What is diverticulitis?

Answer 2

Inflammation of an outpouching of the intestinal wall

Question 3

Which is more associated with bleeding, diverticulosis or diverticulitis?

Answer 3

Diverticulosis

Question 4

Describe the pathogenesis diverticular disease.

Answer 4

• Focal weakness in colonic wall caused by:
  1) Increased luminal pressure
  2) Low fiber diet
• Focal weakness where vasa recta enter muscularis propria

Question 5

What intestinal wall layer is absent that leads to development of diverticula?

Answer 5

Muscularis propria

Question 6

Where are most diverticula located?

Answer 6

Sigmoid colon

Question 7

How do multiple diverticula appear on a barium enema?

Answer 7

“Sawtooth”

Question 8

What are the complications of diverticular disease?

Answer 8

1) Inflammation i.e diverticulitis
2) Perforation
3) Abscess formation
4) Rupture
5) Fistula tract formation

Question 9

What are the symptoms of diverticular disease?

Answer 9

• Abdominal cramping
• Lower abdominal pain
• Sensation of not being able to empty rectum

Question 10

What part of the bowel is most commonly affected by intestinal obstruction?

Answer 10

Small bowel

Question 11

What are the symptoms of intestinal obstruction?

Answer 11

• Pain
• Distention
• Vomiting
• Constipation
• Failure to pass gas

Question 12

What causes most of the cases of intestinal obstruction?

Answer 12

1) Hernia
2) Adhesions
3) Intussusception*
4) Volvulus*

*These are medical emergencies

Question 13

What is a hernia?

Answer 13

Outpouching of the peritoneum through a defect in the abdominal wall

Question 14

What are the major complications of hernias?

Answer 14

1) Strangulation
2) Incarceration

This is a medical emergency when it occurs

Question 15

What is an inguinal hernia?

Answer 15

Portion of the small intestine enters the inguinal hernia

Question 16

What is a direct inguinal hernia?

Answer 16

Medial to the inferior epigastric artery

Question 17

What is an indirect inguinal hernia?

Answer 17

Lateral to the inferior epigastric artery

• Through inguinal canal
• In testes

Question 18

What are “adhesions?”

Answer 18

Fibrous bridges between bowel segments or abdominal wall

Question 19

What are adhesions associated with?

Answer 19

1) Inflammation i.e. peritonitis
2) Surgery
3) Infection
4) Endometriosis

Question 20

What is the major complication of adhesions?

Answer 20

Bowel slips between fibrous bridges resulting in:

• Obstruction
• Infarction

Note this is called an internal hernia*

Question 21

What is Intussusception?

Answer 21

Telescoping of one segment of bowel into an immediately distal segment

Question 22

What causes intussusception in kids?

Answer 22

1) Secondary lymphoid hyperplasia

2) Rotavirus

Question 23

What causes intussusception in adults?

Answer 23

1) Mass

2) Tumor

Question 24

What are the major complications of Intussusception?

Answer 24

• Obstruction

- Infarction (mesenteric vessels become trapped)

Question 25

What is volvulus?

Answer 25

Complete twisting of a loop of bowel

Question 26

What are secondary causes of bowel obstruction?

Answer 26

1) Foreign body (drug mule)

2) Carcinoma

Question 27

How does malabsorption present in kids?

Answer 27

• Diarrhea

- Failure to thrive

Question 28

What type of stool change is typical of malabsorption?

Answer 28

Steatorrhea

Question 29

What are the three phases of nutrient absorption?

Answer 29

1) Intraluminal digestion (saliva, gastric enzymes, pancreatic enzymes…etc.)
2) Terminal digestion (hydrolysis at the brush border)
3) Transepithelial transport

Question 30

What are the three most common malabsorptive disorders in the US?

Answer 30

1) Celiac sprue
2) Chronic pancreatitis
3) Crohn’s Disease

Question 31

What is Celiac spure?

Answer 31

Gluten sensitive enteropathy

Question 32

What is the component of gluten that causes an inflammatory reaction?

Answer 32

Gliadin

Question 33

What cells mediate the inflammation seen in Celiac Sprue?

Answer 33

T-cells

Question 34

What is the hallmark characteristic of a mucosal biopsy in Celiac Sprue?

Answer 34

Proximal villous atrophy

- Preceeded by villous blunting

Question 35

What are patients with Celiac Spure at risk of?

Answer 35

Malignancy

Question 36

What is Tropical Sprue?

Answer 36

Tropical disease–bacterial infection

Question 37

In Tropical Spure, what is one major complication related to the fact that the entire small bowel is affected?

Answer 37

• Folate/B12 deficiency

- Megaloblastic changes

Question 38

How is Tropical Sprue treated?

Answer 38

Broad spectrum antibiotics

Question 39

What is Whipple Disease?

Answer 39

Rare systemic infectious disease caused by the bacterium Tropheryma whipplei

Question 40

What is the hallmark of Whipple Disease?

Answer 40

Macrophages stuffed with PAS+ granules in multiple organ systems

Question 41

What are the clinical features of Whipple Disease?

Answer 41

Fat malabsorption and steatorrhea

• Macrophages compress lacteals (lymphatic vessels of the small intestine that absorb digested fats)
• Chylomicrons cannot be transferred from enterocytes to lymphatics

**Note that Whipple Disease also involves the cardiac valves, lymph nodes, and CNS.

Question 42

How is Whipple Disease treated?

Answer 42

Antibiotics