Intestines 1 Flashcards
What is the most common location for an intestinal obstruction?
Small intestine
80% of all mechanical obstructions occur where?
Intestines
What is a herniation?
Abdominal wall defect leading to intestinal protrusion
What are the four types of intestinal obstructions?
1 herniation
2 adhesion
3 intussusception
4 volvulus
What are adhesions as seen in the intestines?
Inflammation leading to fibrosis of intestinal segments
What is intussusception?
Telescoping of the proximal bowel into the distal segment
What is volvulus?
Twisting a loop of bowel
What gender is more likely to develop a Meckel diverticulum?
Males (2X)
Meckel diverticulum is a congenital, blind-ended outputting of what organ?
Small intestine
Is Meckel diverticulum most commonly symptomatic or asymptomatic?
Asymptomatic
What is another name for Hirschsprung disease?
Congenital aganglionic megacolon
What is the location for Hirschsprung disease?
Rectum, sigmoid colon
What is Hirschsprung disease?
Lack of neurologic ganglia due to defective neural crest cell migration
How and when is congenital ganglionic megacolon diagnosed?
After failure to pass meconium
What is meconium?
First bowel movement
What is the gender bias associated with Hirschsprung disease?
More common in males
More severe in females
What is the treatment for Hirschsprung disease?
Surgical resection
What is another term for ischemic bowel disease?
Ischemic colitis
What arteries are involved with ischemic bowel disease?
Superior and inferior mesenteric
Celiac
What general things can cause ischemic bowel disease?
Thrombosis
Arterial embolism
Non-occusive ischemia
What are ways that IBD can occur by thrombosis?
Atherosclerosis Vasculitis Hypercoagulability Inflammation Stasis (cirrhosis)
What are ways that IBD can occur by an arterial embolism?
Myocardial infarction
Angioplasty
Endarterectomy
What are ways that IBD can occur by non-occlusive ischemia?
Heart failure Hemorrhage (AAA) Shock Dehydration Vasoconstrictive medications
What are miscellaneous ways that IBD can occur?
Volvulus
Dissecting aneurysm
Scarring/stricture
What type of IBD involves possibly hypovolemic shock and frank blood in stool?
Acute
What are the risk factors of IBD?
Elderly
Cardiovascular disease
What is the mortality rate for IBD, and what usually is the cause of death?
50%; septic or hypovolemic shock
What is the treatment IBD?
Prophylactic antibiotics
IV saline
Palliative care
What is the most common location for angiodysplasia in the intestines?
Cecum or ascending colon
What is angiodysplasia?
Malformed dilations and tortuous vessels
What is the hypothesis as to what causes angiodysplasia?
Mechanical stress like constipation
What is the location for hemorrhoids?
Anal and perianal vessels
What are hemorrhoids?
Dilated submucosal venous plexus
What is the most common vascular disorder of the GI tract?
Hemorrhoids
What are the risk factors for hemorrhoids?
Anything that increases intra-abdominal pressure: pregnancy or constipation
Over 50 years old (rarely occurs in those under 30)
What overlying condition can be a risk factor for the development of hemorrhoids?
Liver cirrhosis leading to portal hypertension
What kind of hemorrhoids are found above the anorectal line? Below it?
Internal - above
External - below
What are some signs and symptoms of hemorrhoids?
Perianal pruritus
Frank blood in stool
How long does it take for hemorrhoids to heal on their own?
2-3 days
What are the top three malabsorption conditions of the U.S.?
1 Pancreatic insufficiency
2 Celiac disease
3 Crohn’s disease
Malabsorption issues manifest primarily as what symptom/sign?
Chronic diarrhea
What is steatorrhea?
Excessive fat in feces
What is the term for bloody diarrhea?
Dysentery
What fecal appearances can be associated with malabsorption?
Steatorrhea
Dysentery
What is the clinical term for the noise made by a growling stomach?
Borborygmus
What are the other names for celiac disease?
Celiac sprue
Gluten-sensitive enteropathy
What condition is a noninfectious malabsorption that is immune-mediated?
Celiac disease
Celiac disease is technically a reaction to what substance?
Gliadin (byproduct from gluten found in grains)
What cellular damage is seen in celiac disease?
Lymphocytes damage the villi of the duodenum and jejunum (villous atrophy)
How is celiac disease diagnosed?
IgG and IgA antibodies
Biopsy
What is a big risk factor for celiac disease?
Familial history (HLA-DQ2 or -DQ8)
What is the most common age of diagnosis for celiac d disease?
30-60 years
What race is more likely to be affected by celiac disease?
Caucasians (seen in 1% of the U.S. and Europe)
Although rare, at what pediatric age is celiac disease sometimes diagnosed?
6-24 months
What are the symptoms of celiac disease?
Steatorrhea, diarrhea, failure to gain weight, bloating, abdominal distention
What kind of blood issue and symptoms can accompany celiac disease?
Iron-deficiency anemia; fatigue and pallor
What is the treatment for celiac disease?
Gluten-free diet
Those with celiac disease are at an increased risk for developing what type of cancer?
Intestinal adenocarcinoma
10% of celiac disease patients go on to develop what skin condition?
Dermatitis herpetiformis
What location of the body becomes affected by dermatitis herpetiformis?
Arms, elbows, legs, buttocks
What was the previous name for environmental enteropathy?
Tropical sprue
What population is most commonly affected by environmental enteropathy?
Children ages 2-3
What cycles does one with environmental enteropathy go through?
Mucosal injury
Malnutrition
Inflammation
How does environmental enteropathy negatively affected the children that get it?
Diarrhea/steatorrhea lead to weight loss
Nutritional deficiencies lead to stunted growth
Environmental enteropathy affects 150 million people worldwide living in or traveling to what areas?
Tropics
What is the hypothesis as to what causes environmental enteropathy?
Possible infectious because patients respond to antibiotics, but no microbe has been found
What cellular change is seen in patients with environmental enteropathy
Villus flattening (hinting at autoimmune)
What are other clinical terms for lactase deficiency?
Lactose intolerance
Disaccharidase deficiency
When is lactase deficiency most commonly acquired?
Young adulthood
What kind of reaction is seen when a patient who is lactose intolerant consumes dairy?
Bloating, cramping, gas, and/or diarrhea 30 minutes postprandial
What is the problem with those who are lactose intolerant?
Decreased amounts of lactase or none at all at the S.I. brush border therefore making it unable to digest lactose (found in dairy products)
How is lactase deficiency diagnosed?
Breath hydrogen test (biopsy of SI is unremarkable)
What is the treatment for lactase deficiency?
Avoid lactose
Lactase supplements
What is the most common location for a small intestine neoplasm?
Duodenum
What are the signs and symptoms of a small intestine neoplasm?
Abdominal pain, nausea, vomiting, weight loss
What is the most common acute abdominal condition?
Acute appendicitis
What kind of discomfort is felt in the early stage of acute appendicitis?
Periumbilical/epigastric discomfort
Tenderness in what area is felt in the late stage of acute appendicitis?
Right lower quadrant (deep/constant pain progressing into sharp pain)
What is the gender and age bias associated with acute appendicitis?
Males 20-40 years of age
What is the treatment for appendicitis?
Excision (appendectomy)
What is the most common cause of cute appendicitis (50-80% of the time)?
Obstruction which decreases venous outflow and ischemia leads to inflammation
What can cause death due to acute appendicitis?
Perforation
What is the most common type of tumor of the appendix?
Carcinoid
What can be present on the appendix mimicking a tumor?
Mucocele
