PATH V Flashcards
brunners glands are where
duodenum
where are peyers patches
ileum
majority of GI obstructions are caused by
adhesions, hernias
volvulus
intussusception
what are causes of pseudo obstructions
paralytic ileus
vascular- bowel infarction
myopathies and neuropathies (hirschsprung)
signs of bowel obstruction
pain, distention, vomiting, constipation
what will bowel obstruction show on XR
intestinal obstruction
most common cause intestinal obstruction in US
adhesion between 2 loops of intestin
most common cause intestinal obstruction in children <2 y.o
intussusception
main cause of intussusception in adults
meckels
most frequent cause intestinal obstruction worldwide
hernia (inguinal)
what side are hernias moe likely
right side
what does reducing a hernia mean
it can be manually pushed back into abdominal cavity
if cannot be reduced- incarcerated
bent inner tube or coffee bean sign on abdominal XR could be what
sigmoid volvulus
most likely places for volvulus
sigmoid colon, cecum, small bowel, stomach, large bowel
reason for abdominal adhesions
post operative scar tissue, inflammation, endometriosis
what intestinal vascular disorders can lead to GI bleeds
ischemic bowel disease
angiodysplasia
hemorrhoids
what can cause lower intestinal bleeding
angiodysplasia, colonic carcinoma, IBD, rectosigmoid carcinoma, hemorrhoids, anal fissure
what can cause SI bleeding
IBD, intussusception, meckel diverticulum
how does the small intestine not suffer from chronic blood loss in a small artery
so many collaterals
causes of Ischemic bowel disease
arterial embolism
aterial thrombosis
venous thrombosis
non-occlusive ischemia
causes of arterial emboli
cardiac vegetation, angiography procedure, aortic atheroembolism, superior mesenteric most common
where do arterial thrombosis take place in GI
superior mesenteric from atherosclerosis or systemic vasculitis, dissecting aneurysms
what are causes of non occlusive ischemia in bowel
cardiac failure, shock, dehydration, vasoconstrictive drugs like cocaine, CMV infection
what is a mural infarction? transmural?
mural is through muscularis mucosa and submucosa
transmural is where everything can leak across wall
if there is full thickness infarction and necrosis of bowel wall how many days till perforation
1-4 days
Sx of infarcted bowel
severe periumbilical pain
nausea and vomiting
what does SMA supply
middle colon right colon, ileocolic aa
IMA supplies
left colon, sigmoid and superior rectal artery
what is the watershed zone of colon that is susceptible to ischemia
splenic flexure
what is angiodysplasia
non neoplastic vascular lesion usually in cecum or proximal right colon
tortuous dilation of malformed submucosal and mucosal blood vessels
how common is angiodysplasia
20% significant lower intestinal bleeding
what causes hemorrhoids
persistent elevation in venous pressure
population with hemorrhoids
pregnant females
unusual under 30 y.o common after 50 y.o
cirrhosis assoc (portal HTN)
most common cause hemorrhoids
straining at stool
what is definition diarrhea
increase in stool mass, frequency and or fluifity
>200 gm/day
what is dysentery
low volume, painful bloody diarrhea
what is secretory diarrhea
> 500mL isotonic fluid stoool
persists during fasting
infectious, viral or enterotoxin
osmotic diarrhea
> 500mL hypertonic fluid in stool
stops with fasting
lactase deficiency
exudative diarrhea
mucosal damage causing purulent bloody stools
persists during fasting
bacterial or IBD
derange motility diarrhea
improper neuromuscular fucntion
variable during fasting
neural hormonal or surgical
what is the 72 hr stool fat test
patient on diet of 100 gm fat/day then stool collected for 3 days, if >18-21 gm fat then malabsorption
malabsorption diarrhea
bulky with steatorrhea
stops with fasting
pale smelly floats
celiac, giardia, CF, chronic pancreatitis
what viruses cause secretory diarrhea
rotavirus, norovirus, enteric adenoviruses
astroviruses
what infections that are enterotoxin mediated cause secretory diarrhea
vibrio cholerae
E coli
Bacillus cereus
clostridium perfringens
infectious causes of exudative diarrhea
shigella, salmonella, campylobacter, entamoeba histolytica
infectious causes of malabsorptive diarrhea
giardia
Sx infectious enterocolitis
diarrhea, abdominal pain, urgency, perianal discomfort, incontinence and hemorrhage
what GI virus attack infants 6 mo-2 y.o
rotavirus group A
what is second most common GI virus in US
norovirus
histo features viral enteritis
increased intraepithelial, lamina propria lymphocytes and crypt hypertrophy
Mech of bacterial enterocolitis
- ingestion of preformed toxin: staph, vibrio, C perfringens, C botulinum
- infection by toxigenic organisms: e coli, v cholerae, campylobacter
- infection by enteroinvasive organisms: shigella, salmonella, campylobacter, enteroinvasive E coli
complications of campylobacter enterocolitis
arthritis, guillain barre syndrome
