Small-Bowel Flashcards
Why does patient have polyhydramnios in duodenal atresia
Amnion fluid = swallowed + digestive by baby to decrease volume up a lot of fluid
If it can’t be digestive to atresia and get polyhydramnios a baby can’t pass it through rest of gut
What is duodenal atresia
What genetic condition is it associated with?
Congenital failure Of small bowel to canalise
Assoc with DOWNS
Give three clinical features of duodenal atresia
Double BiPolo
1.polyhydramnios
2.buildup of food @tract – > end@ blind loop – >
bile come in from duodenum – >
regurgitate out = bilious vomiting
- Double bubble sign = stomach + duodenum distension
What is Meckel’s true diverticulum
Failure vitelline duct to involute completely
What is a true Diverticulum
Outpouching of all three layers of bowel wall
At a clinical examination under the umbilicus you feel something firm but soft what is this?
What are the rule of 2’s?
Stool
FITY%!!! 2 Feet from ileocecal valve 2 Inches 2 Types = gastric + pancreatic first 2 Years of life 2% of pop – most common anomaly of GI tract
Presentation of Meckels Diverticulum
BIVO
Bleeding, intussusception, volvulus, obstruction near terminal Ilium
RLQ pain, Melena
What is a volvulus?
What can it lead to?
Where are the common locations of volvulus in adults + infants/children
Twisting of bowl along mesentery
Obstructed bowel, decreased blood supply
– > infarction
@Adults = SIGMOD colon @Infants/children = midgut – Caecum
Define intussusception
Explain how intussusception occurs
Telescoping proximal segment of bowel into distal segment
there’s something peristalsis hooks on to + grabs bowel + drags it forward–>
Bowel dragged along direction of peristalsis – >drag blood supply = infarction – > currant jelly stools
What is the leading edge i.e. underlying cause that allowed bowel to get dragged forward?
Idiopathic/Kid gets a viral infection – >
lymphoid hyperplasia –> wall thickens – >
terminal ileum = dragged to cecum
In adults = tumour pulled into the lumen
What are the two types of small-bowel infarction and how can they occur?
SYMPTOMS?!?!?!???
Transmural infarction:
Vasculitis (polyarteritis nodosa) + AF – >
thrombosis/embolism of artery = SMA
Lupus anticoagulant/polycythaemia vera – > thrombosis of vein
Mucosal infarction:
Hypotension – >decrease BF slightly – >mucosa furthest away from blood supply = ischaemic
Abdominal pain, Decreased bowel sounds,
bloody diarrhoea = redcurrant jelly stools
What are the three types of lactose intolerance is?
Primary = absence of lactase persistence allele
@Asian African Native American
Secondary = gastroenteritis(rotavirus) + AI disease
– > Lose brush border (lactase @ tips of villi)
AR Congenital lactase deficiency = rare due to defective gene
What does the stool, the breath, And lactose intolerance test show?
Stool = decreased PH
Breath = Increased hydrogen content with LI test
LI test = lactone administration – >
abdominal distension + serum glucose increases by less than 20
What is coeliac disease?
Auto immune-mediated damage of small-bowel villi
due to intolerance to Gliadin @gluten @wheat + grain
What are the genes involved in coeliac?
7 + 3 = 10
Coeliac HSR
HLA– DQ(2 +8)
How is the Gliadin transformed in the gut?
Explain how deamidated Gliadin results in tissue damage?
Gilead then the amidated by
tissue trans gut aminase
Deamidated Gliadin = presented by APCs via MHC2– >
T-helper cell mediates tissue damage -
⬆️p(T-cell lymphoma)
How do children and adults present with coeliac disease ?
@Kids = abdominal distension + diarrhoea
@Adults = bloating + chronic diarrhoea
How does a patient at celiac disease get herpetiformis dermatitis
Get IgA deposition at dermal papillae tips – > destroy connection between dermis and epidermis = blister/Vesicle
Lab findings of coeliac disease?
BAAA(get)LD
BBBBBlunt/flat villi + crypt hyperplasia
– auto IgA against Gliadin
– auto IgA against Endomysium
– auto IgA against Tissue transglutaminase
LLLLymphocytes @ lamina propria
⬇️bone DDDDDDensity
What do you know about IgA concentration in coeliac disease patients?
What else do we check for instead?
IgA deficiency
Check for IgG
What does the duodenal biopsy show?
Where does damage occur in the bowel in coeliac disease
Flattening of the villi +
hyperplasia of crypts +
intraepithelial lymphocytes @ lamina propria
Damage: duodenum >jejunum + ileum
Patient presents with refractory coeliac disease despite claiming food dietary control in terms of gluten. What’s the differential diagnosis?
– Small bowel carcinoma
T-cell lymphoma/EATL = Enteropathy associated T-cell lymphoma
What is tropical sprue due to ?
Unknown organism – >damage to small-bowel villi
– >malabsorption
What is the difference between tropical sprue and coeliac disease ?
TIJA
TS @tropical regions
Infectious diarrhoea – >TS
Jejunum (folic acid) deficiency) + Ilium(vitB12 deficiency >duodenum
respond to Antibiotics
