SI path_IBS & others

Question 1

___a___ of 5HT would lead to diarrhea.

___b___ would lead to constipation or an alternating pattern.

Answer 1

a) Decreased reabsorption

b) Desensitization

Question 2

What is Visceral Hypersensitivity?

Answer 2

Lower threshold for visceral pain

somatic pain threshold remains normal

Question 3

Subtle form of gluten intolerance may present as _____ without overt signs of celiac disease

Answer 3

IBS

Question 4

T or F? Small bowel is normally in a constant state of inflammation.

Answer 4

True

Inflammatory cells increased in patients with severe IBS

Question 5

Possible inflammatory pathology in severe IBS?

Answer 5

Possible lymphocytic infiltration of the myenteric plexus with neuron degeneration in severe IBS

Question 6

Brain imaging studies demonstrate altered brain response in patients with IBS
– Activation of the ________ (area that processes visceral signals) after delivered or anticipated rectal distention

Answer 6

mid-singulate cortex

Question 7

3 subtypes of IBS?

Answer 7

1. IBS-D
   - - Diarrhea predominant
2. IBS-C
   - - Constipation predominant
3. IBS-M
   - - Mixed

• patients may switch subtypes long-term

Question 8

Rome III Criteria for IBS diagnosis?

Answer 8

Recurrent abdominal pain or discomfort at least 3 days/month in last 3 months, ass’d w/ 2 or more of the following:

• Improvement w/ defecation
• Onset ass’d w/ a change in frequency of stool
• Onset ass’d w/ a change in form/appearance of stool

No red flags!

Question 9

What are some red flags that would rule out IBS?

Answer 9

• Blood in stool
• Fever
• Onset >50 yrs.
• Noctural symptoms
• Progressive dysphagia
• Weight loss
• Abdominal mass
• Malabsorption

Question 10

Diagnosis?

• Onset 15-35 yrs.
• Bloody diarrhea w/ mucus, fever, abdominal pain, tenesmus, weight loss

Answer 10

Ulcerative Colitis

Question 11

Diagnosis?

• Onset ages 25-35 or 70-80 yrs.
• Fever, abdominal pain, weight loss, diarrhea, fatigue, anorectal fissures, fistulae, abscesses

Answer 11

Crohn’s Disease

Question 12

Diagnosis?

• Chronic diarrhea w/ or w/out blood & mucous
• Dx via microscopy, stool sample, sigmoidoscopy

Answer 12

Infectious Diarrhea

Question 13

Diagnosis?

- Left, lower abdominal pain, fever, altered bowel habits

Answer 13

Diverticulitis

Question 14

Diagnosis?

• Age 50 or older
• Rectal bleeding, altered bowel habits, abdominal or back pain, anemia, occult blood in stool, weight loss

Answer 14

Colorectal malignancy

Question 15

Medications whose side effects may be confused w/ IBS?

Answer 15

Antacids
Laxatives
SSRIs
Thyroid hormones
Metformin
Narcotics
CC-blockers
Anti-cholinergics

Question 16

New patient meeting Rome criteria for IBS & does not have any alarm symptoms. What is next step?

Answer 16

Screen for Celiac’s disease.

If negative, then start first-line therapy for IBS (mainly just symptomatic)

Question 17

Most important “surface enhancer”?

Answer 17

Villi

Question 18

T or F? You should not normally see any inflammatory cells in the villi of the small intestine.

Answer 18

False. Normally see 5-7 inflammatory cells in the villi of the SI.

Any increase beyond this may be diagnostic of Celiac Disease.

Question 19

Where are the stem cells located in the SI?

What other cells do you see here?

Answer 19

Crypts of Lieberkuhn

also see Paneth cells, Neuroendocrine cells, & Goblet cells

Question 20

When there is mucosal injury, the ________ thickness increases relative to the _______.

Answer 20

Crypt (of Lieberkuhn) thickness increases relative to the villi

• • Normal villi:crypt thickness is 3-5:1. Pathologic can be 1:1
    (ex: seen in Celiac Disease)

Question 21

What portion of the GI tract would an Annular Pancreas obstruct?

Answer 21

2nd or 3rd portion of Duodenum

Question 22

Tx possibility of Omphaolcoele? Gastroschisis?

Answer 22

Omphalocoele (visceral herniation into membranous sac)
– Surgical repair

Gastroischisis (involves all wall layers from peritoneum to skin)
– Often non-operable

Question 23

Diagnosis?

Partial persistence of proximal vitelline duct.

Answer 23

Meckel Diverticulum

Viteline duct – connects fetal intestine to yolk sac
(usuall in Ileum)

Question 24

Meckel Diverticulum - Rule of 2?

Answer 24

• 2% of population have them
• 2 inches long
• 2x more prominent in Males vs. Females
• 2 types of heterotropic epithelium
• – Gastric & Pancreatic
• Symptomatic by 2 yrs.

Question 25

T or F? Most Meckel diverticulae are symptomatic

Answer 25

False, most are asymptomatic (>95%)

Question 26

Intestinal scalloping is seen in what condition(s)?

Answer 26

Celiac Disease & Crohn’s Disease

flattening of intestinal villi

Question 27

Major distinguishing histologic factor of Early vs. Late phase Celiac Disease?

Answer 27

Early – still see Villi
(though there’s thickening of Crypts & inflammation)

Late – complete/almost complete flattening & no longer can see Villi
(looks more like colon)

Question 28

Diagnosis?

• Multiorgan disease of GI, CNS, & joints
• Caused by Gram-positive actinomycete that proliferates w/in Macrophages
• More often in Males btwn 40-50

Answer 28

Whipple’s Disease

(

Question 29

Infectious agent that has similar histologic finding to Whipple’s Disease, however different macroscopic presentation & AFB+

Answer 29

Mycobacterium avii

commin in AIDS populations

Question 30

How to differentiate btwn Whipple’s Disease & Mycobacterium avii

Answer 30

Mycobacterium avii is AFB+

Question 31

Infectious agent that presents similar to Crohn’s Disease w/ fistulae, fissuring, ulcers, etc.?

Answer 31

Yersinia enterocolytica

Question 32

Infectious agent that presents w/ intraluminal, crescent-shaped, basophilic protozoa?

Answer 32

Giardia lamblia

Question 33

Clinical manifestations (4) of intestinal obstruction?
Tx?

Answer 33

• Abdominal pain
• Distention
• Vomiting
• Constipation

Tx: usually requires surgical intervention

Question 34

Ischemia to the intestines caused by arteritis/purpuric conditions, would be characterized by what type of tissue damage seen on histology?

Answer 34

Fibrinoid necrosis