Small Bowel Disorders Flashcards
What is a Meckel’s (ileal) diverticulum?
a persistent portion of the embryonic vitteline duct (yolk sac)
What are the rule of 2’s for Meckel’s diverticulum?
- 2% of population
- 2 feet from iliocecal valve
- 2% symptomatic
- 2 inches in length
- 2 types of ectopic tissue (gastric or pancreatic)
- 2yrs MC age at presentation
- 2x more boys
What are the clinical manifestations if symptomatic?
PAINLESS rectal bleeding
or ulceration if gastric tissue
What are the complications of Meckel’s diverticulum?
intussusception
volvulus or obstruction
diverticulitis in adults
What is the management of a Meckel’s diverticulum?
excision if symptomatic
What are the most common causes of a small bowel obstruction?
- post-surgical adhesions (MC!!)
- hernias
- Crohn’s
- malignancy (MC of large bowel tho)
What are the clinical manifestations of a SBO?
crampy abdominal pain
vomiting (bilious if proximal)
diarrhea (early finding)
obstipation (late finding)
What are the clinical exam findings of a SBO?
abdominal distention
hyperactive bowel sounds (early obstruction)
hypoactive bowel sounds (late obstruction)
What is the diagnostic test of choice for a suspected SBO and what will it show?
Abdominal x-ray
air fluid levels in step ladder patter, dilated loops of bowel
What is the management of a SBO?
NPO, IV fluids and bowel decompression via NG tube suction if non-strangulated
Strangulated = surgical!
What is intussusception?
when an intestinal segment invaginates or “telescopes” into adjoining intestinal lumen causing bowel obstruction
Where does intussusception often occur?
at the ileocolic junction
Who does intussusception often affect?
most patients are under 1 year old
usually between 6 months and 18 months
**often occurs after a viral infxn
What is the classic triad for intussusception?
- vomiting
- abdominal pain
- passage of blood per rectum that are “currant jelly stools” (mixture of blood, mucosa, and mucosal tissue)
What is most often found on physical exam in a patient with intussusception?
Dance’s sign = sausage-shaped mass in RUQ
What is the diagnostic test of choice for intussusception?
Barium contrast enema
*Diagnostic AND therapeutic!
What is the management of intussusception?
Barium or air insufflation enema
IV fluids
Surgical resection if refractory/adults!
What is the pathophysiology of Celiac disease?
small bowel autoimmune inflammation 2ry to alpha-gliadin —> loss of villi and absorptive area —> impaired fat absorption
What are the clinical manifestations of Celiac disease?
diarrhea abd pain/distention bloating steatorrhea weight loss dermatitis herpetiformis****
What is the dermatologic clinical manifestation of Celiac disease?
Dermatitis Herpetiformis = pruritic, papulovasicular rash on extensor surfaces, neck, trunk and scalp
What are the diagnostic tests of choice for Celiac disease?
+ endomysial IgA Ab
+ transglutaminase Ab
small bowel bx = definitive diagnosis!
What is the pathophysiology of lactose intolerance?
inability to digest lactose due to low levels of lactase enzyme (normally declines in adulthood)
What are the clinical manifestations of lactose intolerance?
loose stools
abdominal pain
flatulence
borborygmi with ingestion of milk or dairy
What is the diagnostic test of choice for lactose intolerance?
Hydrogen breath test! –> hydrogen produced by undigested lactose
Test usually done AFTER trial of lactose-free diet!!!
