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GI > Small Bowel Pathology > Flashcards

Small Bowel Pathology Flashcards

1
Q

What 2 things can cause bowel ischaemia?

A
  • Mesenteric arterial occlusion

- Non occlusive perfusion insufficiency

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2
Q

What can occlude the superior mesenteric artery and cause bowel ischaemia?

A
  1. Mesenteric artery atherosclerosis

2. Thromboembolism from heart (e.g. A.Fib)

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3
Q

What NON-occlusive conditions can cause bowel ischaemia?

A
  1. Shock
  2. Strangulation obstructing venous return (e.g. hernia, adhesion)
  3. Drugs e.g. Cocaine
  4. Hyperviscosity
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4
Q

Bowel ischaemia is usually ACUTE. TRUE/FALSE?

A

TRUE

- can be chronic (but this is rare)

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5
Q

Describe the progression of infarction in the bowel as the blood supply gradually becomes more compromised.

A
  • MUCOSAL Infarct (this will repair and regenerate as normal)
  • MURAL Infarct (this will regnerate but form a fibrous stricture [like a scar])
  • TRANSMURAL Infarct (this will progress to gangrene and death if this section of the bowel is not resected)
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6
Q

Describe the difference in macroscopic appearance of the bowel between a Mucosal and Transmural infarct

A

Transmural Infarct is MUCH darker in colour

Mucosal = much closer to colour of normal/healthy bowel

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7
Q

What is Meckel’s Diverticulum?

A
  • Result of incomplete regression of vitello-intestinal duct
  • Tubular structure which may contain gastric mucosa

2 inches long
2 foot above Ileocaecal (IC) valve
In 2% of people

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8
Q

What does Meckel’s Diverticulum cause?

A
  • bleeding
  • perforation
  • diverticulitis which mimics appendicitis
  • BUT Commonly asymptomatic
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9
Q

Primary Tumours of the small bowel are common. TRUE/FALSE?

A

FALSE

- secondary more common

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10
Q

Where do secondary tumours of the small bowel metastasise from?

A

Ovary
Colon
Stomach

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11
Q

What primary tumours CAN arise in the small bowel?

A
  • Lymphomas
  • Carcinoid tumours
  • Carcinomas
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12
Q

What type of Lymphoma usually develops in the small bowel?

A

ALL NON-HODGKINS:
- Maltomas (B-cell) derived (due to MALT)

  • Enteropathy associated T-cell lymphomas
    (associated with Coeliac disease)
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13
Q

How are lymphomas of the small bowel treated?

A

• Treated by surgery and chemotherapy

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14
Q

Where do carcinoid tumours normally appear in the small bowel?

A

Commonest site is the appendix

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15
Q

How do carcinoid tumours of the small bowel normally look?

A
  • Small
  • yellow
  • slow growing
  • Locally invasive
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16
Q

What complications can carcinoid tumours cause?

A
  • intussusception
  • obstruction
  • Produce hormone-like substances
17
Q

If a carcinoid tumour metastasises to the liver, what can this cause?

A

“Carcinoid syndrome”

=> Flushing and diarrhoea

18
Q

What conditions are carcinoma of the small bowel associated with?

A

Crohn’s disease and Coeliac disease

19
Q

Small bowel carcinoma is identical to colorectal carcinoma in appearance. TRUE/FALSE?

A

TRUE

20
Q

Does small bowel carcinoma tend to present early or late?

A

LATE

21
Q

Small bowel carcinomas usually metastasise to where?

A
  • Lymph nodes

- Liver

22
Q

What symptoms and signs are common to appendicitis?

A
  • Vomiting
  • abdominal pain
  • RIF tenderness
  • increased WCC
23
Q

What are the potential causes of appendicitis?

A 
Unknown
Faecoliths (dehydration)
Lymphoid hyperplasia
Parasites
Tumours (rare)
24
Q

Describe the pathological appearance of appendicitis?

A
  • Acute inflammation (neutrophils)
  • Mucosal ulceration
  • Serosal congestion, exudate
  • Pus in lumen
  • Walls thicken
  • *Acute inflammation must involve the muscle coat**
25
Q

What are the potential complications of appendicitis?

A
  • Peritonitis
  • Rupture
  • Abscess
  • Fistula
  • Sepsis and liver abscess
26
Q

What is coeliac disease?

A
  • abnormal reaction to a constituent of wheat flour, gluten

- this damages enterocytes and reduces absorptive capacity

27
Q

What conditions does coeliac disease have strong associations with?

A
  • HLA-B8
  • Dermatitis herpetiformis
  • childhood diabetes
28
Q

Describe how gluten causes a reaction in coeliac disease?

A

Gliadin = component of gluten that is the suspected toxic agent

Mediated by T-cell lymphocytes within the small intestinal epithelium
=> ‘intraepithelial lymphocytes’ (IELS)

29
Q

What is the normal lifespan of an enterocyte?

A

72 hours

30
Q

Loss of enterocytes in coeliac disease leads to what consequences?

A
  • loss of villous structure
  • loss of surface area,
  • reduction in absorbtion
  • flat duodenal mucosa
31
Q

Where is a biopsy taken in coeliac disease and why?

A
  • duodenal biopsy most sensitive as proximal bowel is most affected
32
Q

What antibodies can be detected on coeliac serology?

A
  • anti-TTG
  • anti-endomesial
  • anti-gliadin
33
Q

Coeliac disease causes malabsorption of what substances?

A

sugars
fats
amino acids
water and electrolytes

34
Q

Malabsorption of fats in coeliac disease leads to what symptom?

A

steatorrhoea

35
Q

Why are patients with coeliac disease more predisposed to gallstones?

A

Reduced intestinal hormone production leads to reduced pancreatic secretion and bile flow
=> gallstones form

36
Q

What are the consequences of malabsorption in coeliac disease?

A 
Loss of weight
Anaemia (Fe, Vit B12, Folate)
Abdominal bloating
Failure to thrive
Vitamin deficiencies
37
Q

What other consequences can arise from coeliac disease?

A
  • T-cell lymphomas of GI tract
  • Increased risk of small bowel carcinoma
  • Gall stones
  • Ulcerative-jejenoilleitis

GI (33 decks)

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