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Medicine Gastrointestinal > Pathology of the Small Bowel > Flashcards

Pathology of the Small Bowel Flashcards

1
Q

What can cause ischaemia of the small bowel?

A

Mesenteric artery occlusion or non-occlusive perfusion insufficiency

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2
Q

What can cause non-occlusive perfusion insufficiency?

A

Shock, strangulation obstructing venous return (hernia), drugs, hyperviscosity

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3
Q

What usually occurs after a mucosal infarct?

A

Regeneration and the mucosal integrity is restored

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4
Q

What usually occurs after a mural infarct?

A

Repair and regeneration leading to fibrosis and stricture

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5
Q

What usually occurs after transmural infarct?

A

Gangrene and death if not resected

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6
Q

Complications of ischaemia of the small bowel

A

Resolution, fibrosis, stricture, chronic ischaemia, ‘mesenteric angina’, obstruction, gangrene, perforation, peritonitis, death

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7
Q

Meckel’s diverticulum

A

Result of incomplete regression of vitello-intestinal tract

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8
Q

Describe structure and position of Meckel’s diverticulum

A

Tube structure, 2 inches long, 2 foot above ileocaecal valve in 2% of people

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9
Q

Complications of Meckel’s diverticulum

A

Bleeding, perforation or diverticulitis which mimics appendicitis

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10
Q

Primary tumours of the small bowel

A

Lymphomas, carcinoid tumours, carcinomas

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11
Q

Where can secondary tumours of the small bowel metastasise from?

A

Ovary, colon, stomach

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12
Q

What type of lymphoma is associated with the small bowel?

A

Hodgkins lymphoma

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13
Q

Treatment of lymphomas of the small bowel

A

Surgery and chemotherapy

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14
Q

Most common site of carcinoid tumours of the small bowel

A

Appendix

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15
Q

Describe carcinoid tumours of the small bowel

A

Small, yellow, slow growing, locally invasive

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16
Q

What can carcinoid tumours of the small bowel cause?

A

Intussusception

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17
Q

Symptoms of carcinoid tumours of the small bowel

A

Flushing and diarrhoea

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18
Q

Which diseases is carcinoma of the small bowel associated with?

A

Crohn’s and coeliac disease

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19
Q

Where can carcinoma of the small bowel metastasise to?

A

Lymph node and liver

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20
Q

Most common cause of acute abdomen

A

Appendicitis

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21
Q

Pathology of appendicitis

A

Acute inflammation by neutrophils, mucosal ulceration, serosal congestion, exudate, pus in lumen

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22
Q

Complications of appendicitis

A
  • Peritonitis
  • Rupture
  • Abscess
  • Fistula
  • Sepsis and liver abscess
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23
Q

What is coeliac disease caused by?

A

Abnormal reaction to a constituent of wheat flour, gluten, which damages enterocytes and reduces absorptive capacity.

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24
Q

What is the suspected toxic agent in coeliac disease?

25
Q

Enterocytes in coeliac disease

A

Increasing loss of enterocytes due to intraepithelial lymphocyte mediated damage

26
Q

Metabolic effects of coeliac disease

A
  • Malabsorption of sugars, fats, amino acids, water and electrolytes
  • Malabsorption of fats leads to steatorrhea
  • Reduced intestinal hormone production leads to reduced pancreatic secretion and bile flow leading to gallstones
27
Q

Effects of malabsorption in coeliac disease

A

Weight loss, anaemia, abdominal bloating, failure to thrive, vitamin deficiencies

28
Q

Complications of coeliac disease

A
  • T-cell lymphomas of GI tract
  • Increased risk of small bowel carcinoma
  • Gall stones
  • Ulcerative-jejenoilleitis
29
Q

Aetiology of appendicitis

A

Obstruction of lumen by faecolith or tumour, bacterial, viral, parasitic

30
Q

Symptoms of appendicitis

A

Colicky abdominal pain starting around umbilicus which shifts to the right iliac fossa which is worse on coughing/going over speed bumps etc, put off food, nausea and vomiting, flushed

31
Q

Signs of appendicitis

A

Mild pyrexia, mild tachycardia, guarding, rebound tenderness, high WCC

32
Q

Signs specific to appendicitis

A

Rosving’s sign, Psoas, Obturator

33
Q

Rosving’s sign

A

Pressing on left side causes pain in right

34
Q

Psoas

A

Patient keeps the right hip flexed as this lifts an inflamed appendix off the psoas

35
Q

Obturator

A

If appendix is touching obturator internus, flexing the hip and internally rotating will cause pain

36
Q

Differential diagnosis of appendicitis in children

A
  • Gastroenteritis – vomiting profusely and lots of diarrhoea
  • Mesenteric adenitis – lymph nodes in mesentery swell up and stretch the peritoneum and causes pain
  • Meckel’s diverticulum
  • Intussusception
  • Henoch-Schonlein purpura – rash on ankles
  • Lobar pneumonia
37
Q

Differential diagnosis of appendicitis in adults

A
  • Terminal ileitis – colicky paint that comes and goes
  • Ureteric colic
  • Acute pyelonephritis
  • Perforated ulcer
  • Pancreatitis
  • Rectus sheath haematoma
  • Ectopic pregnancy
38
Q

Differential diagnosis of appendicitis in elderly

A
  • Sigmoid diverticulitis
  • Intestinal obstruction
  • Carcinoma of the caecum
39
Q

Investigations for appendicitis

A

Clinical diagnosis, ultrasound, abdominal X-ray, bloods (CRP, WCC), urinanalysis

40
Q

What score can be used to clinically diagnose appendicitis?

A

MANTRELS score

41
Q

MANTRELS score

A 
M = migration of pain to RLQ
A = anorexia
N = nausea and vomiting
T = tenderness in right lower quadrant
R = rebound pain
E = elevated temperature
L = leucocytosis
S = shift of white blood count to left
42
Q

Management of appendicitis

A

Analgesia, antipyretics, antibiotics, appendectomy

43
Q

Treatment for appendix mass

A

Antibiotics, can operate (if able to), theatre if antibiotics failed or complications

44
Q

Complications of appendix mass

A

Tachycardia, worsening pain, increase in size, vomiting or copious NG aspirated

45
Q

Complications of appendectomy

A

Pelvic abscess, wound infection, intra-abdominal abscess, ileus, DVT/PE, portal pyaemia, faecul fistula, adhesions, right sided inguinal hernia

46
Q

Carcinoid of the appendix - what is it a tumour of?

A

Crypts of Lieberkuhn

47
Q

Clinical presentation of small bowel obstruction

A

Colicky pain, absolute constipation, nausea and vomiting (may be faeculent), burping, abdominal distension, loud vomiting ischaemia and perforation

48
Q

Causes of small bowel obstruction (within the lumen)

A

Gallstone, food, bezoar

49
Q

Causes of small bowel obstruction (within the wall)

A

Tumour, Crohn’s radiation

50
Q

Causes of small bowel obstruction (outside the wall)

A

Adhesions, herniation

51
Q

Treatment of small bowel obstruction

A

“drip and suck” - put in a drip and suck out air via NG tube, ABC, analgesia, catheterise, antithromboembolise

52
Q

How long do you drip and suck?

A

Up to 72 hours

53
Q

In surgery, how is the obstruction of the bowel found?

A

By following the collapsed or dilated bowel

54
Q

Causes of mesenteric ischaemia

A

Embolus usually from atrial fibrillation, in situ thrombosis from general gubbedness

55
Q

Diagnosis of mesenteric ischaemia

A

Pain out of proportion to clinical findings, acidosis, elevated lactate

56
Q

Investigations for mesenteric ischaemia

A

CT angiogram

57
Q

Which surgical procedure is required for treatment of mesenteric ischaemia

A

Laparotomy

58
Q

Haemorrhage of the small bowel:

  • Often caused by what?
  • Investigation
  • Management
A
  • Vascular malformations or ulceration
  • CT angiography
  • Interventional radiology
59
Q

Complications of Meckel’s diverticulum

A

Bleed, ulceration, Meckel’s diverticulitis, obstruction, malignancy

Medicine Gastrointestinal (24 decks)

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