Small Bowel Disorders

Question 1

What is a Meckel’s (ileal) diverticulum?

Answer 1

a persistent portion of the embryonic vitteline duct (yolk sac)

Question 2

What are the rule of 2’s for Meckel’s diverticulum?

Answer 2

1. 2% of population
2. 2 feet from iliocecal valve
3. 2% symptomatic
4. 2 inches in length
5. 2 types of ectopic tissue (gastric or pancreatic)
6. 2yrs MC age at presentation
7. 2x more boys

Question 3

What are the clinical manifestations if symptomatic?

Answer 3

PAINLESS rectal bleeding

or ulceration if gastric tissue

Question 4

What are the complications of Meckel’s diverticulum?

Answer 4

intussusception
volvulus or obstruction
diverticulitis in adults

Question 5

What is the management of a Meckel’s diverticulum?

Answer 5

excision if symptomatic

Question 6

What are the most common causes of a small bowel obstruction?

Answer 6

1. post-surgical adhesions (MC!!)
2. hernias
3. Crohn’s
4. malignancy (MC of large bowel tho)

Question 7

What are the clinical manifestations of a SBO?

Answer 7

crampy abdominal pain
vomiting (bilious if proximal)
diarrhea (early finding)
obstipation (late finding)

Question 8

What are the clinical exam findings of a SBO?

Answer 8

abdominal distention
hyperactive bowel sounds (early obstruction)
hypoactive bowel sounds (late obstruction)

Question 9

What is the diagnostic test of choice for a suspected SBO and what will it show?

Answer 9

Abdominal x-ray

air fluid levels in step ladder patter, dilated loops of bowel

Question 10

What is the management of a SBO?

Answer 10

NPO, IV fluids and bowel decompression via NG tube suction if non-strangulated

Strangulated = surgical!

Question 11

What is intussusception?

Answer 11

when an intestinal segment invaginates or “telescopes” into adjoining intestinal lumen causing bowel obstruction

Question 12

Where does intussusception often occur?

Answer 12

at the ileocolic junction

Question 13

Who does intussusception often affect?

Answer 13

most patients are under 1 year old
usually between 6 months and 18 months

**often occurs after a viral infxn

Question 14

What is the classic triad for intussusception?

Answer 14

1. vomiting
2. abdominal pain
3. passage of blood per rectum that are “currant jelly stools” (mixture of blood, mucosa, and mucosal tissue)

Question 15

What is most often found on physical exam in a patient with intussusception?

Answer 15

Dance’s sign = sausage-shaped mass in RUQ

Question 16

What is the diagnostic test of choice for intussusception?

Answer 16

Barium contrast enema

*Diagnostic AND therapeutic!

Question 17

What is the management of intussusception?

Answer 17

Barium or air insufflation enema
IV fluids

Surgical resection if refractory/adults!

Question 18

What is the pathophysiology of Celiac disease?

Answer 18

small bowel autoimmune inflammation 2ry to alpha-gliadin —> loss of villi and absorptive area —> impaired fat absorption

Question 19

What are the clinical manifestations of Celiac disease?

Answer 19

diarrhea 
abd pain/distention
bloating
steatorrhea 
weight loss
dermatitis herpetiformis****

Question 20

What is the dermatologic clinical manifestation of Celiac disease?

Answer 20

Dermatitis Herpetiformis = pruritic, papulovasicular rash on extensor surfaces, neck, trunk and scalp

Question 21

What are the diagnostic tests of choice for Celiac disease?

Answer 21

+ endomysial IgA Ab
+ transglutaminase Ab
small bowel bx = definitive diagnosis!

Question 22

What is the pathophysiology of lactose intolerance?

Answer 22

inability to digest lactose due to low levels of lactase enzyme (normally declines in adulthood)

Question 23

What are the clinical manifestations of lactose intolerance?

Answer 23

loose stools
abdominal pain
flatulence
borborygmi with ingestion of milk or dairy

Question 24

What is the diagnostic test of choice for lactose intolerance?

Answer 24

Hydrogen breath test! –> hydrogen produced by undigested lactose

Test usually done AFTER trial of lactose-free diet!!!