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Block 1 - GI > Path small intestine > Flashcards

Path small intestine Flashcards

1
Q

Meckel Diverticulum

Rule of 2s

A 
2 inches in length 
Within 2 feet of ileocecal valve
2% of the population
2 types of heterotropic rests
2x more common in males
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2
Q

A blind pouch in the small bowel due to persistence of the proximal portion of the vitelline duct

*all 3 layers of the mucosa

A

Meckel diverticulum

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3
Q

Congenital abnormalities of the small intestine

A

Meckel diverticulum

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4
Q

Intestinal obstruction is most common where? Why?

A

Small intestine

Narrower lumen

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5
Q

80% of intestinal obstructions are attributable to 4 things:

A
  1. Hernias
  2. Adhesions
  3. Volvulus
  4. Intussusception
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6
Q
  1. Complete twisting of a bowel loop
  2. Peritoneal wall defects permit sac protraction
  3. Fibrous bands form between bowel loops
  4. Intestinal segment telescopes into the immediately distal segment
A
  1. Volvulus
  2. Hernias
  3. Adhesions
  4. Intussusception
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7
Q

Ischemic bowel disease

A

Abrupt loss of blood supply

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8
Q

Areas most vulnerable to ischemic bowel disease

A

Watershed zones between major vessel branches

-such as splenic flexure between SMA and IMA

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9
Q

Which are more susceptible to ischemia, tips of villi on epithelial cells or crypt epithelial cells?

A

Tips of villi

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10
Q

5 most important causes of ischemia are:

A
  1. Atherosclerosis
  2. Aortic aneurysm
  3. Hypercoagulable states
  4. Embolization
  5. Vasculitis
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11
Q

Global hypoperfusion may be associated with __

A

Cardiac failure
Shock
Vasoconstrictive drugs
Dehydration

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12
Q

Gross morphology:

Mucosal infarction

A

Patchy mucosal hemorrhage

Normal serosa

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13
Q

Gross morphology:

Mural infarction

A

Complete mucosal necrosis

Variable necrosis of submucosa and muscularis propria

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14
Q

Gross morphology:

Transmural infarction

A

Hemorrhagic bowel segments
Serositis
Coagulative necrosis of muscularis propria within 1-4 days
Perforation

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15
Q

Clinical picture of ischemic bowel disease

A 
Late middle age-elderly
Coexisting cardiac or vascular disease
-severe ab pain and rigidity
-bloody diarrhea or melena
-nausea and vomiting
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16
Q

Symptoms of malabsorption

A 
Diarrhea
Flatus
Ab pain
Muscle wasting 
Steatorrhea
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17
Q

Clinical consequences of malabsorption

Deficiencies

A 
Vitamin K
Iron
B6, B12, or folate
Calcium
Magnesium
Vitamin D
Vitamin A
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18
Q

Most common causes of malabsorption in the US

A

Celiac disease
Pancreatic insufficiency
Crohn disease

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19
Q

Immune-mediated malabsorptive process triggered by gluten

Typically people of ___

A

Celiac disease

White European descent

20
Q

Pathogenesis of celiac disease

A

Delayed-type hypersensitivity directed against alpha-gliadin polypeptide, which is resistant to digestive enzymes

*flattened villi

21
Q

Celiac disease carries an increased risk of:

A
  1. S.I. adenocarcinoma
  2. Enteropathy-associated T-cell lymphoma (not true for tropical sprue)
  3. Esophageal squamous cell carcinoma
22
Q

Treatment for celiac disease vs. tropical sprue

A

Gluten free diet

Antibiotics

23
Q

Systemic illness, mainly affects S.I. but can affect CNS, joints, lymph nodes, and other organs

Male:female is 10:1
Treat with antibiotics

Diarrhea, weight loss, lymphadenopathy, arthritis, arthralgias, fever, neurologic, cardiac, or pulmonary disease

A

Whipple disease

24
Q

Carcinoid tumors arise from ___ cells

What predisposes to carcinoid tumors?

A

Neuroendocrine cells of the gut

  • chronic atrophic gastritis
  • Zollinger-Ellison
25
Q

Carcinoid tumors

  • foregut
  • midgut
  • hindgut
A
  • rarely metastasize and are usually cured by excision
  • usually multiple and aggressive
  • usually found incidentally and are very indolent. Excision usually cures
26
Q

Morphology of carcinoids

A

Tan-yellow
Firm
Uniform, small round to oval cells
Nuclei are oval

27
Q 
Cutaneous flushing
Bronchospasm
Increased bowel motility 
Sometimes projectile diarrhea
Right sided cardiac valve thickening
A

Carcinoid syndrome

*rare

28
Q

Kinyoun stain

A

Whipple disease

-shows acid fast bacteria as bright red with blue background

29
Q

Worst prognosis of all small intestine lymphomas

*associated with long standing celiac disease

A

Enteropathy type intestinal T cell lymphoma

30
Q

Most common culprits in bacterial peritonitis

A 
E. coli
Streptococci
S. aureus
Enterococci
C. perfringens
31
Q

Spontaneous bacterial peritonitis is most often seen in patients with ___
Organisms identified most often are ___

A

Cirrhosis and ascites

E. coli and pneumococci

32
Q

Morphology of peritonitis

A

Serosa like and peritoneal surfaces become dull and opaque

  • creamy suppurative material accumulates
  • lots of neutrophils
33
Q

Carcinoid syndrome is thought to arise from excess elaboration of ___

A

Serotonin (5-HT)

34
Q

Most of the tumors of the peritoneum are ___
Primary are ___
Secondary are ___

A

Malignant
Uncommon
Common

35
Q

Primary tumors of the peritoneum arise from ___

Associated with __

A

Peritoneal lining, mesotheliomas, almost always associated with asbestos exposure

36
Q

Secondary tumors of the peritoneum

  • Direct spread to the serosal surface or metastatic seeding is called __
  • The most common tumors producing diffuse serosal implants are ___ and ___
  • Appendiceal mucinous carcinomas may produce ___
A
  • Peritoneal carcinomatosis
  • Ovarian and pancreatic adenocarcinoma
  • pseudomyxoma peritonei
37
Q

Hirschsprung disease

A

Congenital aganglionic megacolon
Rectum is always involved
Associated with RET gene mutation

38
Q

May occur in **Chagas disease, bowel obstruction, IBD, C. diff colitis, and psychosomatic disorders

A

Acquired megacolon

**only in Chagas disease are ganglia actually lost

39
Q

Most common cause of pseudomembranous colitis

A

C. diff

40
Q

Endoscopic findings of pseudomembranous colitis

A

Classic yellow-white exudates or pseudomembranes

  • most commonly on left colon
  • bleed when scraped
41
Q

The pseudomembrane in pseudomembranous colitis is composed of

A

Fibrin
Mucin
Neutrophils

42
Q

Diagnosis of pseudomembranous colitis

A

Cytotoxin A assay
PCR
Enzyme immunoassay (moderate sensitivity)
Latex agglutination assay (lacks sensitivity and specificity)

43
Q

Crohn disease vs. Ulcerative colitis

A

CD: patchy skip lesions, anywhere from the mouth to anus, transmural
UC: continuous, colon and rectum, superficially limited to mucosa

44
Q

Superficial erosions that are small, well-delineated lesions amidst normal mucosa

  • may coalesce into “bear claw” ulcers
  • can result in cobblestoned appearance and inflammatory pseudopolyps
A

Aphthous ulcers

45
Q

Gross resection findings of Crohn disease

A
  1. Serositis
  2. Fat-wrapping/creeping
  3. Fistulas
  4. Thickened bowel wall
  5. Strictures
  6. Skip lesions
  7. Aphthous lesions
  8. Cobblestone appearance
  9. Fissures
46
Q

Microscopic morphology of Crohn disease

A
  1. Abrupt transitions between normal and inflamed mucosa
  2. Inflammation is transmural
  3. Ulceration
  4. Muscle hypertrophy
  5. Chronic mucosal changes
47
Q

Spillover of inflammation from the cecum into the terminal ileum

A

Backwash ileitis

Block 1 - GI (15 decks)

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