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My Gastrointestinal > Small bowel disease > Flashcards

Small bowel disease Flashcards

1
Q

What are the causes of small bowel ischaemia?

A
  • Mesenteric arterial occlusion- mesenteric artery atherosclerosis or thromboembolism from heart
  • Non occlusive perfusion insufficiency- shock, strangulation that is obstructing venous return (hernia or adhesion), drugs or hyperviscosity
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2
Q

What is the pathogenesis of small bowel ischaemia?

A
  • mucosa is sensitive to hypoxia
  • the longer the period of hypoxia the greater the depth of damage to the bowel and the greater the likelihood of complications
  • longer periods of hypoxia lead to stricture and then gangrene
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3
Q

What are the complications of small bowel ischaemia?

A
  • resolution
  • fibrosis, stricture, chronic ischemia, mesenteric angina and obstruction
  • gangrene, perforation, peritonitis, sepsis and death
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4
Q

What is Meckel’s diverticulum?

A
  • Congenital abnormality which is incomplete regression of vitello-intestinal duct
  • May cause bleeding, perforation or diverticulitis
  • Mimics appendicitis
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5
Q

What are the tumours of the small bowel?

A

Primary are rare: lymphomas, carcinoid and carcinomas

Secondary metastases from ovary, colon and stomach are much more common

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6
Q

What are the primary tumours of the small bowel?

A
  • Lymphomas: treated with surgery and chemotherapy
  • Carcinoid tumours: can cause obstruction and present with flushing and diarrhoea if there are metastases in the liver
  • Carcinoma: associated with Crohn’s and Coeliac
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7
Q

What does appendicitis present with?

A

umbilical pain then RIF, one vomit, increased white cell count, slight fever, Rosving’s, Psoas, Obturator and tenderness

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8
Q

What are the causes of appendicitis?

A

unknown, bacteria, viruses, faecolith in the lumen, dehydration, lymphoid hyperplasia, parasites and rarely tumours

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9
Q

What is the pathology of appendicitis?

A

acute inflammation, mucosal ulceration, exudate and pus in lumen

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10
Q

What are the complications of appendicitis?

A

peritonitis, rupture, abscess, fistula and sepsis

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11
Q

What is Coeliac disease?

A
  • lifelong sensitivity to gluten

- autoimmune disorder that leads to the disruption of the structure and function of the small intestine mucosa

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12
Q

How common is Coeliac disease?

A
  • 1 in 100
  • runs in families
  • more women get it
  • strong association to type 1 diabetes in children
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13
Q

What is the cause of Coeliac disease?

A
  • Gliadin in gluten is modified by tTG

- T cells recognise this modifies Gliadin and secrete lymphokines for inflammation so damage to the villi

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14
Q

What is the most useful marker for Coeliac disease and why?

A

Anti-tTG from B cells is produced which can be used as a diagnostic marker

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15
Q

How does Coeliac disease present?

A
  • asymptomatic
  • fatigue
  • wide range of GI symptoms
  • weight loss
  • nutrient deficiencies
  • failure to thrive
  • dermatitis herpetiformis
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16
Q

What does Coeliac disease cause?

A
  • malabsorption of sugars, fats, amino acids, water and electrolytes
  • reduced intestinal hormones so less pancreatic secretion and bile flow so gallstones
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17
Q

What are the investigations for Coeliac disease?

A

Bloods for anti-tTG
Upper GI endoscopy
Biopsy

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18
Q

What is the treatment for Coeliac disease?

A

Gluten-free diet

Supplements for deficiencies

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19
Q

What are the complications of Coeliac disease?

A
  • Malabsorption
  • Osteoporosis and osteomalacia
  • Lactose intolerance due to villi destruction
  • Hyposplenism
  • Reduced fertility
  • Neurological conditions
  • T cell lymphomas in GI tract
  • Gallstones
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20
Q

What is malabsorption?

A

Malabsorption is the failure of absorption of one or more nutrients from the GI tract by defective luminal digestion, mucosal disease or structural disorders

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21
Q

What are the causes of malabsorption?

A
  • caused by disease processes that disrupt digestion, mucosal function and motility
  • Coeliac disease
  • Crohn’s disease
  • cirrhosis
  • biliary obstruction
  • lactase deficiency
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22
Q

What are the components that can be malabsorbed?

A 
Protein
Fat
Carbohydrate
Vitamins
Minerals
23
Q

How does malabsorption present?

A
  • Mild disease is asymptomatic
  • Severe disease presents with diarrhoea and weight loss with abdominal discomfort and bloating
  • Steatorrhoea (pale, bad smelling stools that you can’t flush) is for malabsorption of fat
24
Q

What are the tests for malabsorption?

A 
(usual) Blood tests for anaemia and other deficiency  
Stool microscopy 
Faecal elastase
Upper GI endoscopy 
Imaging
Breath scan
25
Q

How do you treat malabsorption?

A

Treat underlying cause

Correct deficiency

26
Q

What is intestinal failure?

A

arises from a lack of working gut due to intestinal resection or associated with diseased such as small bowel Crohn’s

27
Q

What is intestinal failure characterised by?

A

by inability to maintain protein-energy, fluid balance so weight loss, undernutrition and dehydration

28
Q

What can intestinal failure be due to?

A

obstruction, dysmotility, surgical resection, congenital defect or disease associated loss of absorption

29
Q

What are the three types of intestinal failure?

A

Type 1: short term- surgical ileus, critical problems, GI problems, normal or slightly malnourished
Type 2: medium term- post surgery awaiting reconstruction after admission, septic patients, treat with parenteral nutrition
Type 3: long term- short bowel syndrome, Crohns, radiation, dysmotility, malabsorption

30
Q

What is short bowel syndrome?

A

less than 200cm so there is insufficient length to meet nutritional needs without artificial feeding
(less than 50cm is critical)

31
Q

How can parenteral nutrition be given?

A

centrally or peripherally

32
Q

What is malnutrition?

A

a state of nutrition in which a deficiency so an excess or imbalance of energy, protein or other nutrient causes measurable adverse effects on clinical outcome

33
Q

What can cause malnutrition?

A
  • decreased intake
  • impaired digestion and/or absorption
  • increased nutritional requirements
  • increased nutrient loss
34
Q

What is nasogastric tube feeding?

A

a tube down into the stomach for patients who can’t swallow or are at risk of aspiration

35
Q

What is percutaneous endoscopic gastrostomy?

A

the tube is straight into the stomach

36
Q

What is parenteral feeding?

A
  • providing nutrition intravenously
  • short-term can be provided peripherally but causes inflammation
  • centrally which is into subclavian or jugular vein
37
Q

When is parenteral feeding required?

A
  • after surgery
  • in Crohn’s
  • ischaemia
  • after radiotherapy
38
Q

What are contraindications of parenteral?

A

functioning GI tract, treatment for only a few days or if QOL is not improved by the nutrition

39
Q

What are complications of parenteral feeding?

A

pneumothorax, line sepsis, venous thrombosis or electrolyte disturbances

40
Q

What is the screening tool for malnutrition?

A

MUST score

41
Q

What are the contraindications for enteral tube feeding?

A
  • Lower GI obstruction
  • Prolonged intestinal ileus
  • Severe D or V
  • High enterocutaneous fistula
  • Intestinal ischaemia
42
Q

What are the consequences of malnutrition?

A
  • Impaired immune function
  • Delayed healing
  • Pressure sores
  • Immobility
  • Muscle weakness
  • Cardio-respiratory weakness
43
Q

When is small bowel haemorrhage found?

A

when no bleeding is found on the upper GI endoscopy

44
Q

What is small bowel obstruction caused by?

A

adhesions or herniation, radiation and Crohn’s

45
Q

What does small bowel obstruction present with?

A

distension or vomiting depending on the location of the obstruction

46
Q

What are the investigations for small bowel obstruction?

A

urinalysis, bloods and gases and AXR and contrast CT for diagnosis

47
Q

What is the treatment for small bowel obstruction?

A
  • drip and suck so analgesia, fluids with potassium, catheter and NG tube (Ryles drain to decompress)
  • 72 hours or if there is strangulation, perforation or ischaemia then intervene early
  • lap op
48
Q

What is chronic mesenteric ischaemia?

A

typically pain after eating and is angina of the gut

49
Q

What is acute mesenteric ischaemia?

A
  • infarction of the small bowel
  • little old lady with a sore tummy which will kill her within 12 hours
  • acidosis is ischaemic gut until proven otherwise
50
Q

hat is the presentation of acute mesenteric ischaemia?

A
  • pain that is out of proportion to the clinical signs
  • lactate elevated
  • acidosis on gases
51
Q

Why does the small bowel become ischaemic and not the large bowel?

A

no marginal artery like in the colon so no collateral

52
Q

What are the immediate complications of any surgery?

A
  • local- haemorrhage and enterotomy

- systemic- anaphylaxis

53
Q

What are the early complications of any surgery?

A
  • local- wound infections or pelvic abscess

- systemic- atelectasis, ileus and portal pyaemia

54
Q

What are the late complications of any surgery?

A
  • local- adhesive obstruction, faecal fistula, inguinal hernia or incisional hernia
  • systemic- DVT or PE

My Gastrointestinal (18 decks)

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