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GI > Pathoma - Small Bowel > Flashcards

Pathoma - Small Bowel Flashcards

1
Q

Duodenal atresia

A

duodenum ends in blind loop

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2
Q

Duodenal atresia - cause

A

congenital: failure to canalize

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3
Q

Duodenal atresia - association

A

Down’s Syndrome

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4
Q

Duodenal atresia - clinical presentation

A
  • polyhydramnios
  • “double-bubble sign” (distension of stomach and duodenumw/ tight pyloric sphincter between)
  • Bilious vomiting
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5
Q

Meckel diverticulum

A

outpouching of ALL 3 layers of bowel wall

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6
Q

Meckel diverticulum - cause

A

failure of vitelline duct to involute

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7
Q

Meckel diverticulum - Rule of 2’s

A

2% of population
2 inches long
w/in 2 ft of ileocecal valve
presents w/in first 2 years of life (though usually asymptomatic)

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8
Q

Volvulus

A

twisting of bowel along mesentary

obstruction and infarction

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9
Q

Volvulus - common sites

A

elderly: sigmoid colon

young adults: cecum

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10
Q

Intussusception

A

telescoping of bowel (leads to infarction/obstruction)

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11
Q

Intussusception - clinical signs

A

currant jelly stool

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12
Q

Intussusception - causes

A

children: lymphoid hyperplasia (peyer’s patches stimulated by viral infection)
adults: tumor (“leading edge”)

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13
Q

Small bowel ischemia

A

highly susceptible to ischemic injury (lots of digestion=lots of blood needed)

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14
Q

Small bowel ischemia: types and causes

A

Transmural- thrombus/embolism of SMA

Mucosal - marked hypotension

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15
Q

Lactose intolerance

A

decreased function of lactase enzyme

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16
Q

Lactase enzyme found where?

A

brush border of enterocytes

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17
Q

Celiac disease

A

immune-mediated damage to small bowel due to gluten exposure

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18
Q

Celiac disease: histocompatibility

A

HLA DQ2 + DQ8

19
Q

Celiac disease: clinical presentation

A

diarrhea + bloating (+ failure to thrive in infants)

20
Q

Celiac disease: pathoimmunology

A

gliadin deaminated by tissue transglutamase (tTG)

  • > deaminated gliadin presented by APCs to MHC-II
  • > Helper T cells (T4) mediated damage
21
Q

Dermatitis herpetiformis

A

complication of celiac disease- vesicular lesions

22
Q

Dermatitis herpetiformis: immunopathology

A

IgA deposition at tips of dermal papillae

23
Q

Celiac disease: lab findings

A

IgA antibodies against: endomysium, tTG or gliadin

IgG ab’s also possible if IgA deficient pt

24
Q

Celiac disease: location

A

primarily duodenum (less jejunum/ileum)

25
Q

Celiac disease: diagnosis

A

duodenal biopsy

26
Q

Celiac disease: findings on biopsy

A

flattened villi + hyperplasia of crypts

27
Q

Celiac disease: refractory disease despite good diet

A

small bowel carcinoma or T cell lymphoma

28
Q

Tropical sprue

A

damage to small bowel villi due to unknown organism (->malabsorption)

29
Q

Tropical sprue - clinical presentation

A

similar to celiac disease, except:
occurs in tropical regions
responds to antibiotics
jejunum/ileum most affected

30
Q

Whipple disease

A

systemic destruction of tissue due to T. whippeli infection

31
Q

Whipple disease: characteristic findings

A

macrophages filled with Tropheryma whippeli

32
Q

Whipple disease: location

A

lamina propria of small bowel

33
Q

Whipple disease: clinical presentation

A

steatorrhea/fat malabsoprtion

arthritis, lymph nodes, cardiac valves, CNS

34
Q

Whipple disease: key histological finding

A

foamy macrophages in lamina propria

35
Q

Abetalipoproteinema

A

autosomal recessive deficiency of B-48 and B100

36
Q

Abetalipoproteinemia: clinical presentation

A

B-48 (chylomicrons)->malabsorption

B-100 (VLDL/LDL)-> absent serum VLDL/LDL

37
Q

Carcinoid tumor

A

malignant neuroendocrine cell proliferation

38
Q

Carcinoid tumor: lab findings

A

chromogranin (+) (not specific for bowel tumor)

5-HIAA in urine (carcinoid tumors often secrete seratonin)

39
Q

Carcinoid tumor: location

A

can appear anywhere along gut, small bowel most common

40
Q

Carcinoid syndrome and carcinoid tumor of gut

A

won’t present as syndrome unless it metastasizes to liver (liver destroys seratonin from tumor before it can reach systemic circulation if tumor limited to gut->only get urine metabolites)

41
Q

Carcinoid syndrome: classic presentation

A

bronchospasm, diarrhea, flushing of skin

worsened by EtOH or emotional stress

42
Q

Carcinoid heart disease and bowel

A

also doesn’t occur w/ gut carcinoid tumor unless metastasis

43
Q

Carcinoid heart disease: presentation

A

Right sided valvular fibrosis (COLLAGEN deposition)

->tricuspid regurgitation and pulmonary valve stenosis

44
Q

Why is left side of heart protected in carcinoid heart disease?

A

lungs have MOA- breaks down seratonin into 5-HIAA before it returns to heart

GI (9 decks)

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