Gi path small intestines

Question 1

most common cause of intestinal obstruction in children younger than 2 years of age.

Answer 1

Intussusception

abdominal pain billious vommiting and current jelly stool

Question 2

most common cause of intestinal obstruction in the United States.

Answer 2

Adhesions

Question 3

What causes the most common congenital anomaly of the small intestine?

Answer 3

Failure of involution of the omphalomesenteric (vitelline) duct–> Meckel diverticulum

Question 4

Most common cause Adynamic Ileus

Answer 4

Andominal Surgery

Question 5

Pt. Presents with abdominal distention, nausea, vomiting, constipation, abdominal pain, lack of flatus following surgery

Answer 5

Adynamic (paralytic) ileus is a loss of the normal intestinal peristalsis

Question 6

Pt. Presents with abdominal distention, nausea, vomiting, constipation, abdominal pain, lack of flatus following surgery. Treatment?

Answer 6

Adynamic (paralytic) ileus

IV fluid, correction of electrolytes, avoid opiates/anticholinergics, + NG tube

Question 7

Causes of Adynamic Ileus:

Medications?

Disorders

Answer 7

Other causes include:

peritonitis, trauma, intestinal ischemia,

medications (eg, opiates, anticholinergics),

electrolyte disorders (particularly hypokalemia).

Question 8

Most common cause of surgical abdomen (ie pt presenting with excruciating abdominal pain.

Answer 8

Acute Appendicitis

Question 9

larMost common cause of acute appendicitis in adults vs children

Answer 9

Fecaliths (most common) Lymphoid tissue hyperplasia

Question 10

Location of McBurney’s point

Answer 10

(1/3 the distance from the anterior superior iliac spine to the umbilicus

Question 11

Most common tumor of appendix

Answer 11

Carcinoid Tumur

Question 12

Grossly dilated appendix filled with mucus

Answer 12

Mucocele

Question 13

most common cause of mucocele

Answer 13

Benighn Mucinous cystadenoma

Question 14

malignant neoplasm of appendix

Answer 14

Mucinous cystadenocarcinoma

Question 15

dilatation of lumen of appendix by mucinous secretion usually in an appendix with dysplastic epithelium

Answer 15

Simple mucoceleSimple mucocele

Question 16

Common location of Meckel diverticulum

Answer 16

2 feet proximal to the ileocecal valve

Question 17

Transmural infarction

Answer 17

occurs with occlusion of superior mesenteric artery or mesenteric vein

Question 18

Mucosal infarction

Answer 18

occurs with hypotension (mucosa is farthest from the blood supply)

Question 19

Causes of Arterial thrombosis:

Answer 19

causes include atherosclerosis, vasculitis, and hypercoagulable states

Question 20

Causes of Arterial emboli:

Answer 20

causes include endocarditis, atrial fibrillation, and atherosclerosis.

Question 21

Causes of Venous thrombosis:

Answer 21

causes include hypercoagulable states and abdominal trauma.

Question 22

Pt has abdominal pain, bloody diarrhea, decreased bowel sounds and hypo tension with decreased following heart failure.

Answer 22

Small bowl infarct via arterial infarct

Question 23

small bowel lamina propria with numerous macrophages filled with PAS-positive granules which are lysosomes stuffed with partially digested microorganisms

Answer 23

Whipple Disease

Question 24

Pathophysiology of Whipple Dz

Answer 24

Macrophages compress lacteals and prevent chylomicrons from entering lacteals Presents with fat malabsorption, steatorrhea, weight loss Prompt response to antibiotics

Question 25

increase in intraepithelial lymphocytes, marked atrophy or total loss of villi in more proximal small bowel (particularly duodenum, jejunum), hyperplasia of crypts

Answer 25

Celiac Dz

Question 26

Pathophysiology of Celiac Dz

Answer 26

T4 hypersensitivity with anti-gliadin, anti-tissue transglutaminase, and anti-endomysial IgA antibodies. CD4+ lymphocytes which release cytokines that lead to tissue damage Pts with IgA deficiency often develop IgG antibodies.

Question 27

What part of the small bowl is most affected by Celiac Dz

Answer 27

Decreased mucosal absorption primarily affects distal duodenum and/or proximal jejunum.

Question 28

This defect of the bowl presents with features of both obstruction and infarction.

Answer 28

Volvulus

twisting of bowl around mesenteric point

sigmoid in elderly

cecum in youth

Question 29

Location of volvulus in adults vs children

Answer 29

Adults:large redundant loops of sigmoid colon Kids: cecum

Question 30

Colicky abdominal pain, bilious vomiting, and “currant jelly” stools.

Answer 30

Intussusception

Question 31

Signs of Intussusception

Answer 31

Colicky abdominal pain, bilious vomiting, and “currant jelly” stools.

Question 32

Cause of Intussusception in children vs adults

Answer 32

idiopathic or related to reactive lymphoid hyperplasia (Peyer’s patches) Adults: tumor

Question 33

bowel fails to canalize during weeks 3–7 of embryologic development

Answer 33

Duodenal Atresia

Question 34

Answer 34

Duodenal Atresia

Question 35

Answer 35

Generalized gaseous distension of the both large and small bowel loops without frank transitional zone

Adynamic ileus

Question 36

TRopical Sprue

Answer 36

• Idiopathic celiac-like disease found almost exclusively in people living in or visiting the tropics
• Often seems to occur after infectious diarrheal illness
• Micro: loss of villi similar to celiac disease
• Damage is seen throughout small bowel (duodenum, jejunum, ileum)
• Damage in duodenum may lead to iron deficiency
• Damage in jejunum may lead to folate deficiency
• Damage in ileum may lead to Vitamin B12 deficiency
• TX: broad spectrum antibiotics are often effective which would seem to indicate an infectious etiology

Question 37

infants present with severe fat malabsorption, steatorrhea, failure to thrive. Tests show absent chylomicrons, VLDL, LDL.

Dz?

Mutation

Pathophysiology

What would you see on a blood smear?

Answer 37

Abetalipoproteinemia

• •Rare autosomal recessive dis­ease
• Loss-of-function mutations in the gene encoding microsomal triglyceride transfer protein (MTP
• •Leads to deficiency of apolipoprotein B-48 and apolipoprotein B-100
• –B48 needed to make chylomicrons
• •Deficiency leads to fat malabsorption
• –B100 needed to make VLDL and LDL
• •Acanthocytes seen on peripheral blood smear
• •Deficiency results in decreased plasma LDL and VLDL

Question 38

What would be metabilized due to this tumor?

Answer 38

Carcinoid tumor

metabolite 5-HIAA

Question 39

Weight loss, diarrhea, arthritis, fever, adenopathy

Answer 39

Whipple dz

Question 40

A 56-year-old Caucasian man with a history of nonspecific arthritis complains of chronic GI upset. He has had diarrhea almost daily for several months now. He has lost 10 lbs unintentionally. His family has also noticed some loss of memory, such as forgetting where his keys are or forgetting someone’s birthday.:

What stain could help with dx?

Treatment?

Answer 40

Whipple

PAS for foamy macrophages

Trimethoprim-sulfamethoxazole (TMP-SMX)

Question 41

Lab studied for Acute Appendicitis

Alvarado score: What score to do CT?

What cells cause “Left shift”

What other cells are increased?

Answer 41

Alvarado score ≥ 7, and for Alvarado score ≤ 3, no CT for diagnosing appendicitis, as appendicitis is unlikely

§Leukocytosis: WBC >10,000/mm3 (~70% of pts)

§Polymorphonuclear cells (segmented neutrophils and bands) predominate, called “left shift” (>90% of pts)

§Urinalysis: Small amounts of hematuria, pyuria (~30% of pts)

§C-reactive protein: Nonspecific inflammatory marker elevated in ~70% of pts. When paired with an elevated WBC can increase the likelihood of appendicitis.

Question 42

A 2-day-old neonate presents with bilious vomiting and irritability. On physical examination, she has abdominal distention and high-pitched bowel sounds. Barium enema radiograph reveals a dilated sigmoid colon with a column of barium resembling a “coffee bean”.

Answer 42

Volvulus: SMA strangulation