Intestines 1 Flashcards by Rebecca Warnecke

What is the most common location for an intestinal obstruction?

Small intestine

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80% of all mechanical obstructions occur where?

Intestines

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What is a herniation?

Abdominal wall defect leading to intestinal protrusion

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What are the four types of intestinal obstructions?

1 herniation
2 adhesion
3 intussusception
4 volvulus

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What are adhesions as seen in the intestines?

Inflammation leading to fibrosis of intestinal segments

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What is intussusception?

Telescoping of the proximal bowel into the distal segment

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What is volvulus?

Twisting a loop of bowel

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What gender is more likely to develop a Meckel diverticulum?

Males (2X)

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Meckel diverticulum is a congenital, blind-ended outputting of what organ?

Small intestine

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Is Meckel diverticulum most commonly symptomatic or asymptomatic?

Asymptomatic

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What is another name for Hirschsprung disease?

Congenital aganglionic megacolon

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What is the location for Hirschsprung disease?

Rectum, sigmoid colon

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What is Hirschsprung disease?

Lack of neurologic ganglia due to defective neural crest cell migration

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How and when is congenital ganglionic megacolon diagnosed?

After failure to pass meconium

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What is meconium?

First bowel movement

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What is the gender bias associated with Hirschsprung disease?

More common in males

More severe in females

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What is the treatment for Hirschsprung disease?

Surgical resection

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What is another term for ischemic bowel disease?

Ischemic colitis

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What arteries are involved with ischemic bowel disease?

Superior and inferior mesenteric

Celiac

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What general things can cause ischemic bowel disease?

Thrombosis
Arterial embolism
Non-occusive ischemia

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What are ways that IBD can occur by thrombosis?

Atherosclerosis
Vasculitis
Hypercoagulability
Inflammation
Stasis (cirrhosis)

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What are ways that IBD can occur by an arterial embolism?

Myocardial infarction
Angioplasty
Endarterectomy

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What are ways that IBD can occur by non-occlusive ischemia?

Heart failure
Hemorrhage (AAA)
Shock
Dehydration
Vasoconstrictive medications

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What are miscellaneous ways that IBD can occur?

Volvulus
Dissecting aneurysm
Scarring/stricture

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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