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My DEMS I > Small Bowel and Appendix > Flashcards

Small Bowel and Appendix Flashcards

1
Q

Tumors of the appendix

A

About 1/2= carcinoid (neuroendocrine tumor), mets to liver can produce serotonin syndrome (episodic flushing, diarrhea, wheezing and right sided valvular heart disease)
-Mets rare if tumor pseudomyxoma peritonei charac by diffuse collections of gelatinous material thru the abdomen

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2
Q

Appendicitis

A
  • mid abdominal pain that migrates to the RLQ
  • Nausea and vomiting -High fever, WBC count and severe pain suggest perforation.
  • IV fluids, IV antibiotics and surgical resection are the treatment.
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3
Q

Plicae circulares

A

more in prox jejunum, absent terminal ileum

ileum empties into cecum of LI

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4
Q

absorption and transport of fluids

A

9L secreted/ingested
8.9 L absorbed
100 ml excreted

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5
Q

Malabsorption/maldigestion

A
  • inadequate absorp of nutrients
  • Clinical signs: weight loss, diarrhea, steatorrhea, vitamin deficiencies
  • Pale, bulky, malodorous stool: float, hard to flush, oily residue
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6
Q

Causes of malabsorption

A 
Surgery:
-gastric bypass
-small bowel resection
Bacterial overgrowth
Meds:
cholestyramine-ADEK
phenytoin, folate
Pancreatic insufficiency
Liver disease
Intestinal inflammation/villous flattening (celiac sprue, Whipple's disease, tropical sprue)
Ulceration
Ischemia
Infiltration (amyloidosis)
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7
Q

What test might you use to dx fat malabsorption?

A

Sudan fat stain

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8
Q

Pancreatic insufficiency

A

90% burned out
Lipid (first) then protein then rarely carb malabsorption
-chronic pancreatitis
-CF

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9
Q

Liver disease

A

bile needed for absorption of lipids

  • Cirrhosis (decreased func of hepatocytes, decreased bile formation)
  • Biliary obstruction
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10
Q

Gastric Bypass

A

B-II, Roux-en Y

inadequate mixing of food with biliary and pancreatic secretions

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11
Q

Gastric Bypass Vitamin Deficiencies

A

B12, Fe, Ca, Vit D deficiencies are the most common
-Vit C, Cu rare
Prevention: multivitamin
Monitoring recommended

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12
Q

Small Bowel Bacterial Overgrowth

A

Normal:

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13
Q

Vitamin levels with bacterial overgrowth and

Dx

A

fat soluble vitamins and B12 deficiency (bacteria deconjugate bile salts, bacteria consume B12)

Folate: normal to high (bacterial production)

Dx: 
-Aspiration of duodenum w/ culture
-Glucose-hydrogen breath test
-empiric treatment with antibiotics
Treatment: antibiotics (eg Ciprofloxacin)
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14
Q

Sx of Vit A def

A

night blindness

xerophthalmia

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15
Q

Sx of Vit D def

A

Osteomalacia

-bone mineralization defects

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16
Q

Sx of Vit E def

A

rare in adults

hemolytic anemia

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17
Q

sx of vit K def

A

clotting dysfunction

-PT

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18
Q

Celiac Sprue

A
  • gluten sensitive enteropathy (wheat, barley, rye)
  • inflammatory disease of small intestine
  • loss of villi, crypt hyperplasia, lymphocytes
  • 80% asx (0.5-1% of US pop)
  • incidence increases with age
19
Q

Signs/sx of celiac sprue

A 
Abdominal distension
Abdominal pain
Anorexia
Bulky, sticky, pale stools
-Steatorrhea
Diarrhea
Flatulence
Failure to thrive
-Weight loss
-Fatigue
Vomiting
20
Q

Atypical signs/sx of celiac sprue

A 
Iron deficiency Anemia
Dermatitis Herpetiformis
Liver function tests
-AST, ALT elevations
Cerebellar ataxia
Osteoporosis
Oral apthous ulcers
21
Q

Celiac pathogenesis

A

-assoc w/ autoimmune diseases: thyroiditis, Type-I DM
-HLA-DQ2, HLA-DQ8 (40% US)
APC MHC II present gluten peptides

CD4+ Tcell response
All have ab to tissue transglutaminase (TTG)

22
Q

Dx of Celiac sprue

A

Dx:

  • finding on SI biopsy
  • Serologic tests: anti-TTG, anti-endomysial antibodies, anti-gliadin IgA and IgG

Tx: gluten free diet

23
Q

Findings on endoscopy for celiac

A

scalloped duodenal folds

24
Q

Tropical sprue

A
  • residents/visitors of tropics
  • Cause: bacterial toxins or colonization of aerobic coliform bacteria

Classic presentation: Megaloblastic anemia from B12 and folate deficiency

Diagnosis: intestinal biopsy with villous flattening and travel history

Treatment: Antibiotics, B12, and folate

25
Q

Whipple’s Disease

A

RARE (

26
Q

Mesenteric Ischemia

A

Atherosclerosis, Clot, Radiation

Chronic: 2 of 3 major vessels occluded
post-prandial abdominal pain, weight loss, sitophobia, malabsorption

Acute: embolus, severe abdominal pain

27
Q

Malabsorption diagnostic tests

A 
Focused testing-clinical scenario
Fecal Fat
Vitamin levels
CBC, albumin
CT-small bowel, liver, pancreas, bile ducts
Endoscopy
28
Q

Small Intestinal Tumors

A

RARE primary tumors (

29
Q

Two main causes of diarrhea

A

decreased fluid/elec absorption
increased secretion

-occurs when colonic water load exceeds absorptive capacity

30
Q

Diarrhea classification

A

Fatty

  • malabsorption
  • maldigestion

Watery

  • osmotic
  • secretory

Inflammatory/exudative

Functional

31
Q

Watery diarrhea– osmotic

A

Carb malabsorption:
lactose
sorbitol (gum)
fructose (non-diet drinks and many commercial foods)

Osmotic laxatives:

  • Magnesium containing
  • Phosphate, sulfate (colonoscopy bowel preps)

Osmotic diarrhea: presence of OSMOLAR GAP

*ie presence of poorly absorbed luminal osmols

32
Q

Osmotic vs secretory diarrhea

A

Osm gap= 290-2(stool sodium + potassium)

diff >50mOsm, diarrhea is osmotic

33
Q

Lactose intolerance

A

> 50% of world down-regulates lactase after weaning

–>diarrhea (osmotic), flatulence (colonic bacteria)

34
Q

Secretory watery diarrhea

A 
Bacterial toxins
	-V. cholerae, E. coli enterotoxins
Neuroendocrine tumors
	-gastrinoma, VIPoma, carcinoids, calcitonin
Ileal bile salt malabsorption
Stimulant laxatives
Disordered motility/regulation 
	-Diabetic neuropathy, postvagotomy, irritable bowel syndrome
35
Q

Bile acid induced diarrhea

A
  • from ileal dysfunction (only site of ACTIVE bile acid absorption
  • increased bile acid into colon–> colonic secretion of fluid/elec–> diarrhea
36
Q

Fatty diarrhea

A

Malabsorption syndromes
-Mucosal diseases (Celiac disease, Whipple’s disease)
-Short-bowel syndrome
-Small bowel bacterial overgrowth
Maldigestion/Malabsorption
-Pancreatic insufficiency
-Inadequate luminal bile salt concentration (chronic liver disease, biliary obstruction)

37
Q

Inflammatory diarrhea

A

Infection

Inflammatory Bowel Disease

  • Crohn’s Disease
  • Ulcerative Colitis

Ischemia

38
Q

Fecal leukocytes in intestinal infections

A

Present:
Shigella
Campylobacter
Enterohemorrhagic, enteroinvasis E. coli

Variable:
Salmonella
Yersinia
Clostridium difficile (pseudomembranous colitis)

Absent:
V. cholerae
Enterotoxigenic E. coli
Giardia lamblia

39
Q

Inflammatory diarrhea dx

A

Infection:
Usually Stool Culture
Endoscopy

Ischemia:
CT scan
Endoscopy-colon

Inflammatory Bowel Disease:
Endoscopy

40
Q

IBS

A

Abdominal Pain and altered bowel habits in the absence of an organic cause:
Pain improved with defecation
Pain onset with change in stool frequency
Pain onset with change in stool appearance
Constipation and/or Diarrhea
10-15% of the population North America

Possible mechanisms:
Visceral hypersensitivity
Carbohydrate malabsorption
-FODMAPS fermentable oligo-, di-, and monosaccharides and polyols (Fructose, fructans (wheat polymers e.g.inulin) sorbitol, lactose,)
Low grade inflammation
41
Q

When to be concerned about IBS

A 
Weight Loss
Rectal bleeding
Anemia
Nocturnal symptoms
Electrolyte abnormalities
Elevated inflammatory markers
42
Q

What could be the result of longstanding Celiac?

A

T cell lymphoma

43
Q

Arterial supply to SI, LI

A

SMA: part of duodenum, entire SI, half of colon

IMA: left colon and rectum

Collateral circ bt SMA and IMA via marginal arteries and Arc of Riolan

My DEMS I (26 decks)

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