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pathology 2 > pathology of the small intestine > Flashcards

pathology of the small intestine Flashcards

1
Q

symptoms of small intestine pathology

A 
pain 
nausea and vomiting 
symptoms of nutrient deficiency 
loss of appetite/loss of weight 
diarrhoea 
constipation 
fever
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2
Q

fever as a symptom

A

infection related pathology

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3
Q

signs of small intestinal pathology

A 
tenderness 
abdominal distension 
palpable mass 
haemorrhage 
peritonitis/systemic infection
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4
Q

haemorrhage as a sign in small intestine pathology

A

haematemasis/malena

anaemia/positive faecal occult blood

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5
Q

investigations for small bowel pathology

A

physical examination
imaging - xray, U/S, CT, MRI
lab tests - stool for microbiology, blood for serology
endoscopy

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6
Q

hernia

A

hernia - when a loop bwel gets stuck in a defect in the abdominal wall and becomes incarcerated and vascular supply becomes compromised usually leading to ischaemia

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7
Q

adhesions

A

adhesions - fibrosis usually in a surgical area causing bpowel to stick together abnormally obstructing the lumen of the bowel

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8
Q

vovlolus

A

volvolus - bowel loops on itself and causes luminal obstruction and compromise of the blood supply

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9
Q

intussusception

A

intussusception - more common in children, telescoping of bowel through itself effecting the lumen and the blood supply

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10
Q

small bowel obstruction requires

A

hernia, adhesions, volvolus and intussusception all require surgical intervention to correct themselves

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11
Q

meckle’s diverticulum

A

remnant vitaline duct

viteline duct should regrew but it doesn’t

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12
Q

rule of 2 in meckle’s diverticulum

A

2% of the population
within 2 feet (60cm) of the ileocaecal valve
2 inches ling
x2 as common in males
are most often symptomatic by age 2 - only approx 4% are ever symptomatic

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13
Q

ischaemia of the small bowel

A

can happen due to obstruction
thrombosis/emboli can cause it
congestion of blood causes it to look red

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14
Q

coeliac disease

A

gluten sensitive enteropathy
chronic disorder of the digestive tract
an inability to tolerate glaidinn, the alcohol soluble fraction of gluten
underdiagnosed

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15
Q

immunological response to gliadin in coeliac disease

A

endogenous tissue transglutamidase (TTG) converts gliadin from a neutral to a negatively charged protein
in some people this induces IL-15 in enteric epithelium, leading to proliferation of NK cells and expression of cell surface markers on epithelial cells that cause T cells to attack them
antiglaidin antibodies are frequently found in untreated patients as is IgA to smooth muscle endomysium and TTG
inflammatory mediated damage to enteric epithelial cells, with T cell infiltration, atrophy of villi in small bowel and loss of absorptive surface leads to mal digestion and malabsorption of many nutrients

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16
Q

triggers of coeliac disease

A

triggers are unknown - genes may play an important role

17
Q

pathology og coeliac disease

A

inflammatory mediated damage to enteric epithelial cells, with T cell infiltration, atrophy of villi in small bowel and loss of absorptive surface leads to mal digestion and malabsorption of many nutrients

18
Q

morphological changes in pathology of coeliac disease

A

loss of villous height- atrophy
lymphocytes entering epithelial cells and causing damage
more mitotically active epithelial cells as they are trying to regenerate
due to increases mitosis - crypt hyperplasia

19
Q

tissue translgutaminase

A

tTG
turns gliadin into negatively charged protein
in coeliac patients this leads to cascade of immune signalling leading to epithelial damage
IL-15 causes expression of proteins recruiting NK cells causing cell damage
may also activate B cells to produce antibodies

20
Q

clinical features of coeliac disease

A 
chronic but variable diarrhoea 
steatorrhea 
abdominal bloating and cramps 
flutulence and borborygmus 
weight loss 
fatigue
21
Q

complications of coeliac disease

A 
anaemia 
bleeding disorders 
osteopeniaa 
seizure disorders and neuromusclular irritation due to hypocaalcaemia 
growth restriction/failure to thrive 
amenorrhoea
infertility 
skin disorders - dermatitis herpetiformis 
risk of malignancy
22
Q

diagnosis of coeliac disease

A

clinical history, serology, endoscopy, histology

23
Q

serology for diagnosis of coeliac disease

A

anti-tissue transglutaminase antibody
anti-modified or deaminated gliadin antibodies (AGA)
anti-endomysial antibodies (EMA)
anti-reticulin antibodies (ARA)

24
Q

coeliac disease differential diagnosis

A 
other food intolerance/allergies 
Crohn's diseases 
topical sprue 
infections - giardiasis, helicobacter, cryptoosporidium, viruses 
drug reactions - NSIADS, chemotherapy 
immune system abnormalities
25
Q

tropical sprue

A

causes similar histological changes to coeliacs

only in tropical countries

26
Q

coeliac disease management

A

strict lifelong gluten free diet
vitamin and mineral supplements
antti-inflammatory agents for severe intestinal injury
close clinical follow up and management for complications

27
Q

autoimmune enteropathy

A

x-linked disorder characterised by severe persistent diarrhoea
seen often in young children
intestinal epithelial damage from anti-enterocyte and anti-globlet cell antibodies
leads to small intestinal atrophy
severe familial form termed IPEX results from gremlin mutation of FOXP3 gene

28
Q

common variable immunodeficiency

A

one of the most common symptomatic primary immunodeficiencies
characterised by los levels of circulating immunoglobulins
both genetic and sporadic forms
symptoms vary widely and across body systems

29
Q

GI symptoms of common variable immunodeficiency

A

abdominal pain, bloating, nausea, vomiting, diarrhoea and weight loss
signs of malabsorption

30
Q

small bowel histology of common variable immunodeficiency

A

may appear normal or show non-specific damage

plasma cells are reduced or absent

31
Q

giardia

A

protozoan infection associated with malabsorption and chronic diarrhoea
spread by a feacal contamination of water
present on the surface of the mucosa but does not invade the tissue

32
Q

malignancies

A

adenocarcinoma
neuroendocrine tumours
gastrointestinal stromal tumours
lymphoma

33
Q

GIST

A

gastrointestinal stromal tumour

composed of mesenchymal cells

34
Q

metastatic melanoma

A

common metastasis to the small intestine

may cause intussusception

pathology 2 (47 decks)

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