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BMS150 Post-MT2 > Intestinal Pathology Part II > Flashcards

Intestinal Pathology Part II Flashcards

1
Q

80% of intestinal obstructions are due to what? (4)

A
  • Herniations
  • Adhesions
  • Intussusception
  • Volvulus
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2
Q

10-20% of intestinal obstructions are caused by what?

A

Tumors or infarcts

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3
Q

Intestinal obstruction is due to distention of the intestine caused by what?

A

Accumulation of gas and fluid proximal to and within the obstructed segment

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4
Q

With an intestinal obstruction, loss of fluid and electrolytes may be extreme, causing what? (3)

A
  • Hypovolemia
  • Renal insufficiency
  • Shock
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5
Q

What may fluid loss be from?

A
  • Vomiting
  • Accumulation of fluids in the lumen
  • Sequestration of fluid into the intestinal wall and peritoneal cavity
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6
Q

Where do most mechanical obstructions occur? Why?

A

Small bowel - smaller lumen, smaller diameter

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7
Q

Weakness or defect in the abdominal wall causing protrusion of peritoneum?

A

Hernia

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8
Q

What happens once the bowel has become trapped in a herniation? (5)

A
  • Venous outflow obstructed
  • Swelling of bowel
  • Increased intramural pressure
  • Decreased arterial perfusion
  • ISCHEMIC BOWEL
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9
Q

How are intestinal herniations named?

A

Based on location - inguinal, femoral, umbilical

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10
Q

Trapped bowel?

A

Incarceration

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11
Q

Trapped and ischemic bowel?

A

Strangulation

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12
Q

Most frequent cause of obstruction worldwide?

A

Intestinal herniation

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13
Q

Risk factors for intestinal hernia? (3)

A
  • Chronic cough
  • Chronic straining
  • Overweight
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14
Q

Clinical features of herniation? (4)

A
  • Acute or chronic pain
  • Bulges under the skin
  • Nausea and vomiting
  • Constipation
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15
Q

What usually occurs due to a tumor in the small bowel that disrupts motility?

A

Intussusception (telescoping)

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16
Q

What are usually due to an inflammatory process that link two segments of bowel together or compress it from the outside?

A

Adhesions

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17
Q

What are common causes of adhesions?

A
  • Crohn’s, diverticulitis
  • Abdominal surgery, cancers, infections
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18
Q

What tend to occur around a mesenteric point of attachment - both the vascular supply and the lumen are occluded at the site of twisting?

A

Volvulus

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19
Q

What presents similarly to a strangulated hernia and is a surgical emergency?

A

Severe acute mechanical obstruction

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20
Q

If blood flow is impaired, as in with a volvulus, it can cause mild hypoxia/ischemia and impaired function or __________

A

Food intolerance

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21
Q

Def. Ileus?

A

Bowel experiences greatly decreased motility - functional obstruction

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22
Q

Causes of functional bowel obstructions? (5)

A
  • Post-surgical
  • Intra-abdominal inflammation, hemorrhage, ischemia
  • Metabolic or electrolyte abnormalities
  • Medications that impair bowel motility
  • Sepsis or peritonitis
23
Q

What are some causes of Intestinal Ischemia? (5)

A
  • Atrial fibrillation, valvular disease, embolic disease
  • Hypercoagulable states
  • Global hyperfusion
  • Severe atherosclerosis
  • Post-vascular surgery
24
Q

Two phases of intestinal ischemia?

A
  1. Hypoxic injury
  2. Reperfusion injury
25
Q

Hypoxic injury?

A

Epithelium, muscular layers are relatively resistant to ischemia, so damage is relatively limited early on

26
Q

Reperfusion injury?

A

Free radical production, neutrophil infiltration, and release of inflammatory mediators, such as complement
proteins and TNF = more severe damage

27
Q

What do acute and complete arterial obstruction tend to cause?

A

Transmural infarction

28
Q

What does coagulative necrosis cause?

A

Perforation and inflammation of the serosa or peritoneum

29
Q

Vulnerable intestinal areas?

A

Watershed zones

30
Q

Splenic flexure?

A

Where the superior and inferior mesenteric arterial circulations terminate

31
Q

Sigmoid colon and rectum?

A

Where the inferior mesenteric, pudendal, and iliac arterial circulations terminate

32
Q

Population that intestinal ischemia tends to occur in?

A

Older individuals with co-existing cardiac or vascular disease

33
Q

Typical presentation of acute transmural infarction?

A
  • Sudden, severe abdominal pain and tenderness
  • Nausea and vomiting
  • Bloody diarrhea
  • Grossly melanotic stool
34
Q

Signs of intestinal ischemia overlap with what?

A

Acute appendicitis, perforated ulcer, and acute cholesystitis

35
Q

Malformed submucosal and mucosal blood vessels?

A

Angiodysplasia

36
Q

Where does angiodysplasia most often occur?

A

Cecum or right colon

37
Q

Angiodysplasia accounts for ____ of major episodes of lower intestinal bleeding

A

20%

38
Q

Pathogenesis of angiodysplasia contributing to mechanical and congenital factors?

A
  • Focal dilation and tortuosity of overlying submucosal and mucosal vessels
  • Cecum develops greatest wall tension
  • Degenerative vascular changes
39
Q

Clinical features of angiodysplasia?

A
  • Hematochezia, melena, or iron deficiency
  • Often asymptomatic if bleeding mild
40
Q

Most common abdominal surgical emergency?

A

Appendicitis

41
Q

Major complication of appendicitis?

A

Perforation

42
Q

Traditional model of appendicitis?

A

A fecalith obstructs the lumen of the appendix, resulting in bacterial and mucous “build up”

43
Q

Appendicitis can lead to distention and ischemia, which may be severe enough to cause?

A

Gangrene

44
Q

______ infiltrate the full thickness of the mucosa and ____ can accumulate and fill the appendiceal lumen

A

Neutrophils; pus

45
Q

In cases of perforation, the wall “bursts” or leaks ______, ________, and _______ into the peritoneum causing peritonitis

A

Fecal material, mucous, and bacteria

46
Q

Encapsulation of the appendix and leaked material can lead to?

A

Abscess formation (greater omentum may encapsulate the “mess”)

47
Q

“Free” perforation into the peritoneal cavity can cause? (4)

A
  • 3rd spacing
  • Vascular collapse
  • Sepsis
  • Portal vein thrombosis (rare)
48
Q

What else can cause appendicitis?

A
  • Mesenteric adenitis (big lymph nodes) from IBD or infection
  • Cancer (rarely)
49
Q

Appendicitis pain?

A

RLQ pain at McBurney’s point - often accompanied by nausea, vomiting, and anorexia

50
Q

During pregnancy, where is appendix located?

A

RUQ

51
Q

Symptoms of pelvic appendicitis?

A

Inguinal or suprapubic pain accompanied by dysuria. urinary frequency, diarrhea, tenesmus

52
Q

Symptoms of perforation?

A
  • High temp
  • Hypotension
53
Q

Diagnosis of appendicitis?

A

CT (best sensitivity and specificity) or ultrasound

54
Q

Treatment for appendicitis?

A

Immediate surgical removal

BMS150 Post-MT2 (17 decks)

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