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Y4 Gastrointestinal > Pathology of the small bowel > Flashcards

Pathology of the small bowel Flashcards

1
Q

What is Meckles diverticulum ?

A
  • It is a congenital diverticulum of the small intestine.
  • It is an embryological remnant of the vitellointestinal duct and contains ectopic ileal, gastric or pancreatic mucosa
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2
Q

What is the rule of 2s reagrding meckles diverticulum ?

A
  • occurs in 2% of the population
  • is 2 feet from the ileocaecal valve
  • is 2 inches long
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3
Q

What are the presenting features of meckles diverticulum ?

A

Usually asymptomatic but if it causes symptoms:

  • Abdo pain mimicking appendicitis (when causing meckles diverticulitis)
  • Rectal bleeding
  • intestinal obstruction - secondary to an omphalomesenteric band (most commonly), volvulus and intussusception
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4
Q

Who is meckles diverticulum more common in, males or females ?

A

Much more common in males

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5
Q

What are the potential complications of meckles diverticulum ?

A
  • Bleed (haematochezia) = fresh red blood
  • Ulcerate/meckels diverticulitis - more common in adults
  • Obstruction - more common in adults
  • Malignant change (0.5%)
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6
Q

What is meckles diverticulum the most common cause of ?

A

Painless massive GI bleeding requiring a transfusion in children between ages 1-2

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7
Q

What is the management of meckles diverticulum ?

A

Removal if it has a narrow neck or is symptomatic

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8
Q

Are primary tumours of the small bowel common ?

A

No they are very rare

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9
Q

What are the potential primary tumours of the small bowel ?

A
  • Lymphomas - non-hodgkins (B or T cell)
  • Carcinoid tumours
  • Carcinomas
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10
Q

What type of tumours and where from are much more common of the small bowel ?

A

Metastases (secondary) from:

  • Ovary
  • Colon
  • Stomach
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11
Q

What is the treatment of primary lymphomas of the small bowel ?

A

Surgery and chemo

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12
Q

What is a carcinoid tumour ?

A
  • A rare small, yellow ,slow growing tumours which is usually locally invasive
  • They produce serotonin (5-HT) + other hormones
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13
Q

Where do carcinoid tumours usually arise ?

A
  • Appendix
  • Ileum
  • Rectum
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14
Q

What complications can carcinoid tumours result in ?

A
  • Can cause intussusception, obstruction
  • Can metastases to liver causing carcinoid syndrome
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15
Q

If a carcinoid tumour metastases to the liver how do they result in carcinoid syndrome ?

A

Because they are then able to now release serotonin into the systemic circulation

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16
Q

What are the features of carcinoid syndrome ?

A
  • Flushing (often earliest symptom)
  • Diarrhoea
  • bronchospasm
  • hypotension
  • right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
  • other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
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17
Q

What is used to manage carcinoid syndrome ?

A
  • Octreotide (somatostatin analogue) - used to counter peripheral effects and tumour mediators
  • Diarrhoea: cyproheptadine or loperamide may help
18
Q

What are carcinomas of the small bowel associated with ?

A

Crohns disease and coeilac disease

19
Q

How do carcinomas of the small bowel tend to present ?

A

Late with metastases to the lymph nodes and liver

20
Q

Who is appendicitis most common in ?

A
  • Young people aged 10-20
  • Note it can occur at any age however
21
Q

What are the typical symptoms of appendicitis?

A
  • Peri-umbilical pain (central) which migrates to the RIF
  • Pain is often worse on coughing or going over speed bumps (children cant hop on one leg)
  • Nausea with one or two episodes of vomiting - marked is unusual
  • Mildly pyrexic - 37.5-38oC.
  • Anoxrexia (loss of appetite)
22
Q

What are the signs of appendicitis ?

A
  • L ocalised peritonism (in RIF) causing gaurding or rebound - Generalised peritonitis if perforation has occurred
  • Rovsings sign - palpation in LIF causes pain in the RIF
  • PR exam may feel - boggy sensation if pelvic abscess is present, or even right-sided tenderness with a pelvic appendix
  • Increased WCC
  • Mild pyrexia and tachycardia
  • Psoas - Patient keeps the right hip flexed as this lifts an inflamed appendix off the psoas
  • Obturator - If appendix is touching obturator internus, flexing the hip and internally rotating will cause pain
23
Q

How is appendicitis usually diagnosed ?

A

1st line = raised inflam markers + history/exam findings

24
Q

What needs to be excluded in aptients with appendicitis ?

A
  • Urine dipstick + pregnancy test - to exclude UTI or pregnancy/ectopic pregnancy
25
Q

If diagnosis is uncertain what investigation is used 1st line to diagnose appendicitis ?

A

1st line = US

26
Q

What scoring system may be used to help diagnose appendicitis ?

A

MANTRELS score

27
Q

What is the treatment of appendicitis ?

A

1st line = laproscopic appendectomy + prophylactic IV antibiotics

28
Q

Describe the pathogenesis of coeliacs disease

A
  • It is a disorder caused by sensitivity to the protein gluten.
  • Repeated exposure leads to villous atrophy which in turn causes malabsorption.
29
Q

What are the clinical features of coeliacs disease?

A
  • Chronic or intermittent diarrhoea
  • Steatorrhoea
  • Failure to thrive (in children)
  • Persistent or unexplained GI symptoms including nausea and vomiting
  • Prolonged fatigue (‘tired all the time’)
  • Recurrent abdominal pain, cramping or distension
  • Sudden or unexpected weight loss
  • Unexplained iron-deficiency anaemia, or other unspecified anaemia (iron def. main one)
30
Q

What are the potential complications of coeliacs disease?

A
  • T-cell lymphomas of GI tract
  • Increased risk of small bowel carcinoma
  • Gall stones
  • Ulcerative-jejenoilleitis
  • Anaemia: iron, folate and vitamin B12 deficiency (folate more common than B12)
  • Vitamin deficiencies
  • hyposplenism
  • osteoporosis, osteomalacia
  • lactose intolerance
  • Subfertility
31
Q

What conditions are strongly associated with coeliacs disease?

A
  1. Dermatitis herpetiformis
  2. Autoimmune disorders (type 1 diabetes mellitus and autoimmune hepatitis & thyroiditis).
32
Q

What genetic mutations is coeliac disease strongly associated with ?

A

HLA-DQ2 and HLA-DQ8

33
Q

What should be done prior to testing for coeliacs disease?

A

If patients are already taking a gluten-free diet they should reintroduce gluten for at least 6 weeks prior to testing.

34
Q

How is coeliacs disease diagnosed ?

A
  • 1st line = serology test IgA tTGA (or IgA EMA)
  • 2nd line if serology pos = dudoenal biopsy to confirm or exclude coeliacs

TGA = tissue transglutimase

EMA = endomyseal antibody

35
Q

If the serology test for coeliacs is negative what should be done ?

A

Check there is not a IgA deficiency, to reduce the risk of a false-negative specific IgA test.

36
Q

If a patient with suspected coeliacs disease has a IgA deficiency what should be tested for on serological testing ?

A

IgG tTGA, IgG EMA, or IgG deamidated gliadin peptide [DGP] (not the IgA versions)

37
Q

What is the treatment of coeliacs disease?

A

Gluten-free diet

38
Q

List some of the gluten containing foods

A
  • Wheat
  • Barley
  • Rye
  • Oats
  • rice
  • potatoes
  • corn (maize)
39
Q

What should patients with coeliacs disease be immunised against and why ?

A

Pneumoccocal vaccine every 5years - due to hyposplenism

40
Q

Go over this complication list of any surgery

A
41
Q

How a carcinoid tumour diagnosed ?

A
  • 24hr urinary 5-HIAA
  • CXR + chest/pelvis MRI/CT
  • plasma chromogranin A y may also be done

Y4 Gastrointestinal (28 decks)

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