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Intestine Disorders Flashcards

1
Q

What are plicae circulares?

A

Folds in the small intestine

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2
Q

What are red spots seen on the small intestine?

A

Peyer’s patches

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3
Q

What is the main epithelial adaptation of the small intestine?

A

Lots of villi

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4
Q

What type of pain does a small bowel obstruction have?

A

Colicky or central

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5
Q

Apart from pain, what are other symptoms of a small bowel obstruction?

A

Constipation, burping, vomiting, abdominal distension

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6
Q

How do you assess the state of a patient with a small bowel obstruction?

A

Urinalysis, bloods, ABGs

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7
Q

How do you confirm the diagnosis of a small bowel obstruction?

A

AXR and contrast CT

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8
Q

How do you treat a small bowel obstruction?

A

ABC’s, analgesia, fluids with potassium, catheter, NG tube

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9
Q

What are complications can patients with small bowel obstructions get?

A

Hypokalaemia and alkalotic

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10
Q

What are the two different types of small bowel ischaemia?

A

Mesenteric artery occlusion or non-occlusive perfusion insufficiency

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11
Q

What are causes of mesenteric arterial occlusion?

A

Mesenteric artery atherosclerosis, thromboembolism from the heart e.g. AF

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12
Q

What are causes of non-occlusive perfusion insufficiency?

A

Shock, hernia, drugs, hyperviscosity

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13
Q

The degree of bowel infarction increases with what?

A

The time of ischaemia

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14
Q

What is the outcome of a mucosal infarct?

A

Regeneration

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15
Q

What is the outcome of a mural infarct?

A

Stricture

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16
Q

What is the outcome of a transmural infarct?

A

Gangrene and death if not resected

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17
Q

How is small bowel ischaemia diagnosed?

A

Acidosis, lactate elevated, CRP can be normal, WCC raised, CT angiogram

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18
Q

Meckel’s diverticulum results from what?

A

Incomplete regression of vitello-intestinal duct

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19
Q

Where should the vitello-intestinal duct normally connect?

A

Yolk sac

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20
Q

What is Meckel’s diverticulum?

A

Tubular structure about 2 inches long about 2 foot above the ileocaecal valve

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21
Q

What can Meckel’s diverticulum cause?

A

Bleeding, perforation, diverticulitis

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22
Q

Where is secondary metastases to the small bowel commonly from?

A

Ovaries, colon, stomach

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23
Q

What are primary tumours of the small intestine?

A

Non-Hodgkin’s lymphoma, carcinoid tumours, carcinomas

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24
Q

What are carcinoid tumours?

A

From the neuroendocrine system

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25
Q

How can lymphomas be treated?

A

Surgery and chemotherapy

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26
Q

Where is the commonest site of a carcinoid tumour?

A

Appendix

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27
Q

What type of tumour can cause production of hormone like substances?

A

Carcinoid

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28
Q

What do carcinoid tumours cause if they metastasise to the liver?

A

Flushing and diarrhoea

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29
Q

What are primary carcinomas of the small bowel associated with?

A

IBD

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30
Q

What is the commonest cause of acute abdominal pain?

A

Appendicitis

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31
Q

How does appendicitis present?

A

Vomiting, abdominal pain (specifically RIF), RIF tenderness, increased WCC

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32
Q

What are some signs of acute appendicitis?

A

Mild pyrexia, tachycardia and guarding

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33
Q

What are investigations for appendicitis?

A

Ultrasound, AXR, bloods (WCC, CRP), urinalysis

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34
Q

How is appendicitis managed?

A

Analgesia, antipyretics, antibiotics, surgery

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35
Q

What are complications of appendicitis?

A

Peritonitis, rupture, abscess, fistula, sepsis

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36
Q

Acute inflammation must involve what?

A

Muscle coat

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37
Q

Coeliac disease is caused by an abnormal reaction to what?

A

Gliadin- a component of wheat, flour and gluten

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38
Q

What does the abnormal reaction in Coeliac disease do?

A

Damages enterocytes and reduces absorptive capacity

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39
Q

What other conditions can Coeliac disease be related to?

A

Dermatitis herpetiformis, childhood diabetes

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40
Q

The abnormal reaction in Coeliac disease is mediated by what?

A

T lymphocytes

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41
Q

What will be seen on histology of Coeliac?

A

Loss of villous structure (villous atrophy)

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42
Q

Where are the lesions from Coeliac worse?

A

Proximal bowel

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43
Q

What are good things to test for on serology of Coeliac?

A

Anti- tissue transglutaminase, anti- gliadin

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44
Q

What is a comfirmative test for Coeliac?

A

Biopsy

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45
Q

Malabsorption of fats in Coeliac leads to what?

A

Steatorrhoea

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46
Q

Reduced intestinal hormone production in Coeliac leads to what?

A

Reduced pancreatic secretions and bile flow leading to gallstones

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47
Q

How can Coeliac present?

A

Weight loss, anaemia (Fe, B12, folate), abdominal bloating, failure to thrive

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48
Q

What are some complications of Coeliac?

A

Increased risk of small bowel lymphoma/carcinoma, gallstones

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49
Q

What causes lactose malabsorption?

A

Deficiency of lactase

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50
Q

What is a common history of lactose intolerance?

A

Diarrhoea, abdominal discomfort and flatulence following lactose ingestion

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51
Q

How is lactose intolerance diagnosed?

A

Lactose breath hydrogen test

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52
Q

What is tropical sprue?

A

Colonisation of the intestine by an infectious agent or alterations in intestinal bacterial flora

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53
Q

How is tropical sprue diagnosed?

A

Biopsy

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54
Q

How is tropical sprue treated?

A

Tetracycline and folic acid

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55
Q

How is Whipple’s disease diagnosed and treated?

A

Diagnosed by microscopy and treat with antimicrobial

56
Q

What is short bowel syndrome defined as?

A

Small bowel < 200cm

57
Q

What is the indication for home parenteral nutrition in short bowel syndrome?

A

< 50cm bowel

58
Q

What is the last resort treatment for short bowel syndrome?

A

Small bowel transplant along with liver transplant

59
Q

What are indications for a transplant for short bowel syndrome?

A

Loss of venous access or liver disease

60
Q

What is diverticular disease related to?

A

Low fibre diet and increased intra-luminal pressure

61
Q

Where in the colon is diverticular disease common?

A

Sigmoid colon

62
Q

What will be seen in a colonoscopy of diverticular disease?

A

Holes in the bowel wall through the mucosa

63
Q

What are clinical features of diverticular disease?

A

LIF pain/tenderness, sepsis and altered bowel habit

64
Q

How do you treat uncomplicated diverticular disease?

A

Oral or no antibiotics- no IV fluids

65
Q

What are complications of diverticular disease?

A

Inflammation, rupture, abscess, fistula, bleeding

66
Q

In diverticular disease, a fistula to where is most common?

A

Bladder

67
Q

What is 1st line treatment for complicated diverticular disease?

A

Percutaneous or laparoscopic drainage

68
Q

What is 2nd line treatment for diverticular disease?

A

Remove section of colon or primary resection/anastomoses

69
Q

What will show withering of crypts and smudging of lamina propria?

A

Ischaemic colitis

70
Q

Who is ischaemia of the bowel most common in?

A

Elderly patients, particularly with pre-existing CVS disease

71
Q

What are some causes of ischaemic colitis?

A

Embolus, atherosclerosis of mesenteric vessels, shock or vasculitis

72
Q

What are complications of ischaemic colitis?

A

Bleeding, rupture, stricture

73
Q

What will any type of colitis show on an X-ray?

A

Smooth colon- lead piping

74
Q

What shows patchy yellow membranous exudate on the mucosal surface?

A

Pseudomembranous colitis

75
Q

What will pseudomembranous colitis show on histology?

A

Explosive lesions on mucosa

76
Q

What is a common cause of pseudomembranous colitis?

A

Use of broad spectrum antibiotics and C. diff infection

77
Q

What are symptoms of pseudomembranous colitis?

A

Diarrhoea and bleeding

78
Q

How is pseudomembranous colitis treated when severe?

A

Colectomy- may be fatal

79
Q

What causes a thickness of sub-epithelial collagen?

A

Collagenous colitis

80
Q

What does collagenous colitis present with?

A

Watery diarrhoea

81
Q

What will show normal crypt architecture with a massive increase in intra-epithelial lymphocytes?

A

Lymphocytic colitis

82
Q

What type of colitis is common in people with a history of cancer?

A

Radiation colitis

83
Q

What will cause a busy epithelium with no irregular crypts?

A

Infective colitis

84
Q

What can be causes of large bowel obstruction?

A

Cancer, benign strictures, volvulus or hernias

85
Q

What is the normal treatment for a large bowel obstruction?

A

Insert a stent

86
Q

What are some symptoms of large bowel obstruction?

A

Constipation, abdominal distension, pain and vomiting

87
Q

What is the relative onset of vomiting in small and large bowel obstructions?

A

Early in small bowel obstruction and late in large bowel obstruction

88
Q

What happens in a volvulus?

A

Bowel gets twisted on mesentery

89
Q

What part of the large bowel is a volvulus most common in?

A

Sigmoid colon

90
Q

What can the area infarcted by a sigmoid volvulus become?

A

Gangrenous

91
Q

How is the diagnosis of sigmoid volvulus made?

A

Plain AXR and rectal contrast

92
Q

Irritable bowel syndrome is a chronic, relapsing condition involving what?

A

Abdominal pain, bloating and change in bowel habit

93
Q

What are slightly more uncommon symptoms of IBS?

A

Mucus in stool, urgency, tenesmus, aggravated by stress

94
Q

What are investigations for IBS?

A

FBC, plasma viscosity, CRP, TTG (check for coeliac)

95
Q

What are some lifestyle options for IBS?

A

Regular meal times, reduced fibre/tea/coffee

96
Q

What medications can be given for IBS?

A

Anti-diarrhoeals, spasmodics, depressants

97
Q

What is the Rome II criteria for IBS?

A

Recurrent abdominal pain and discomfort for at least 3 days per month for 3 months and 2 or more of:

  • Improvement with defaecation
  • Associated with a change in stool frequency
  • Associated with a change in stool form
98
Q

What is a polyp?

A

A protrusion above an epithelial surface

99
Q

What do most polyps tend to be?

A

Adenomas

100
Q

Why should all adenomas be removed?

A

They are all dysplastic and precursors of adenocarcinomas

101
Q

Colorectal cancer is more common on which side?

A

Left

102
Q

What are some presenting complaints of left sided colorectal cancer?

A

PR bleeding, altered bowel habit, obstruction

103
Q

What are some presenting complaints of right sided colorectal cancer?

A

Anaemia and weight loss

104
Q

When is hereditary non-polyposis coli more common?

A

< 100 polyps involved

105
Q

What is familial adenomatous polyposis more common?

A

> 100 polyps involved

106
Q

Which genetic predisposition to colorectal cancer has an early onset and which late?

A

FAP- early onset

HNPCC- late onset

107
Q

Which genetic predisposition to colorectal cancer has a defect in DNA mismatch repair?

A

HNPCC

108
Q

Which genetic predisposition to colorectal cancer has a defect tumour suppression?

A

FAP

109
Q

What mode of inheritance do both HNPCC and FAP involve?

A

Autosomal dominant

110
Q

Which genetic predisposition to colorectal cancer affects right sided tumours and which affects all throughout the colon?

A

Right side- HNPCC

All through- FAP

111
Q

What type of tumours does HNPCC produce?

A

Mucinous tumours

112
Q

What type of tumours does FAP produce?

A

Adenocarcinoma

113
Q

Which of the genetic predispositions to colorectal cancer involves inflammation?

A

HNPCC

114
Q

What does an oncogene do?

A

Normally promotes cell growth and division, when mutated causes excess of this

115
Q

What does a tumour suppressor do?

A

Normally suppresses growth and division, when mutated allows this

116
Q

What are the sites of colorectal cancer from most to least likely?

A 
Rectum
Sigmoid colon
Ascending colon
Transverse colon
Descending colon
117
Q

What are lifestyle factors which are protective against colorectal cancer?

A

Vegetables, fibre, exercise

118
Q

What are lifestyle factors which are causative of colorectal cancer?

A

Processed meat, smoking, alcohol, obesity

119
Q

What are general findings of colorectal cancer?

A

Anaemia, cachexia, lymphadenopathy, mass, distension

120
Q

What are potential emergency presentations of colorectal cancer?

A

Obstruction, bleeding, perforation

121
Q

How is colorectal cancer diagnosed?

A

CT colonoscopy, colonoscopy, sigmoidoscopy, barium enema, faecal occult blood test

122
Q

What is the main treatment for colorectal cancer?

A

Surgery

123
Q

When is radiotherapy used in colorectal cancer?

A

Pre or post op to prevent recurrence, or palliatively

124
Q

What causes intestinal failure?

A

Inability to maintain adequate nutrition or fluid status via the intestines

125
Q

Which types of intestinal failure are acute?

A

1 and 2

126
Q

Which types of intestinal failure are chronic?

A

3

127
Q

What is a common cause of acute intestinal failure?

A

Post operatively

128
Q

What is a common cause of chronic intestinal failure?

A

Short gut syndrome

129
Q

What are treatments for type 1 intestinal failure?

A

Replace fluids, correct electrolytes, acid suppression with PPIs

130
Q

When should parenteral nutrition be used in type 1 intestinal failure?

A

If unable to tolerate oral foods/fluids for more than 7 days

131
Q

What are treatment options for type 3 intestinal failure?

A

Home parenteral nutrition, intestinal transplant, bowel lengthening (children)

132
Q

What can being malnourished to feeding lots cause?

A

Severe heart failure

133
Q

What is parenteral nutrition dependent on?

A

Venous access

134
Q

What lines can be used for parenteral nutrition?

A

Peripherally inserted central catheter or tunnelled catheter (Hickman line)

135
Q

Where can a Hickman line enter?

A

Subclavian or internal jugular vein

136
Q

What are complications of parenteral nutrition lines?

A

Pneumothorax or arterial puncture

GI (17 decks)

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