Small Int & Appendix

Question 1

Appendix (Info and Tumors)

Answer 1

appendix average 9cm, appendicitis most common

RARE - carcinoid most common (metastasis to liver - serotonin syndrome)

Question 2

Small Int (D, J, I)
Malabsorption symptoms

Answer 2

Weight loss, diarrhea, steatorhhea (fecal fat - floater, hard to flush) –> test with Sudan stain

Question 3

Malabsorption causes

Answer 3

Pancreatic insuff: no lipase, trypsin etc. (90% loss of fxn)
Live insuff: no bile –> can;t break down fats
Surgery: eg gastric bypass (malabsoprtion by design) –> common defic in B12, Fe, Ca, Vit D (treat with mulitvitamin)

Question 4

Malabsorption vitamin deficiencies

Answer 4

A: night blindess, xerophthalmia
D: osteomalacia
E: poor nerve conduction
K: clotting dysfxn

Question 5

Intestinal obstruction (causes)

Answer 5

Herniation (usually inguinal canal, can lead to infarction)
Adhesions (post-surgical)
Volvulus (twisting of bowel)
Intussuscpetion (telescoping of bowel)

Question 6

Intestinal obstruction (pres/diagnx/treat)

Answer 6

Constipation
Endoscopy
Treatment depends on cause

Question 7

Bacterial Overgrowth (cause/pres)

Answer 7

Anatomic abnormalities
Hypomotility (diabetes/scleroderma)
Intestinal obstruction
Decreased acid secretion
PRESENTS with STEATORRHEA

Question 8

Bacterial Overgrowth (diagnx/treat)

Answer 8

Aspirate duodenum with culture
Vit ADEK and B12 defic with NORMAL TO HIGH FOLATE
Also glucose-hydrogen breath test
TREAT: empirical abx (e.g CIPROFLAXIN)

Question 9

Celiac Disease (info/cause)

Answer 9

GLUTEN (alpha-gliadin peptide) SENSITIVE ENTEROPATHY –> infl dz of SI
~1% of population
Assoc with autoimmune: DM type 1, thryoiditis, Sjogren, F:M, 2:1
Assoc with EAT lymphoma (enetropathy-asscoiated-T cell lymphoma) and SI adenocracinoma
Genes: HLA-DQ2, DQ8

Question 10

Celiac Dz (pres) ADULT

Answer 10

abd pain, diarrhea, weight-loss, fatigue
Steatorrhea
Flatulence
DERMATITS HERPETIFORMIS (itchy extensor surfaces)
Osteoporosis
And some more ...

Question 11

Celiac Dz PEDIATRIC (classic and atypical)

Answer 11

CLASSIC: 6-24 mos, irritibality, abd distension, anorexia, diarrhea, failure to thrive, weight loss, muscle wasting
ATYPICAL: older kids with abd pain, nausea, vomiting, bloating constipation

Question 12

Celic Dz (diagnx/treat)

Answer 12

Gold standard: SI biopsy
Loss of surface villi (blunting) and scalloped duodenal folds on endoscopy
Positive IgA (or other Ab) to transglutaminase
AST/ALT elevation
IRON defic anemia
Tissue biopsy: villous blunting, increased intraepithelial lymphocytes, crypt hyperplasia
TREAT WITH GLUTEN FREE DIET

Question 13

Tropical Sprue

Answer 13

Bacteria from tropics
MEGALOBLASTIC ANEMIA FROM B12/FOLATE DEFIC
intestinal biopsy with villous flattening/hx of travel
TREAT WITH ABX (6MO-1YR) B12, FOLTAE

Question 14

Whipple’s Dz

Answer 14

V rare, cause by T. whippelii
FEVER, JOINT PAIN, DIARHHEA, ABD PAIN, CNS-NEURO SX
Macrophages filled with whipple bacilli with PAS stain (on biopsy, PCR) - villi distended by macrophages
ONE YEAR OF ABX

Question 15

Mesenteric Ischemia

causes/pres

Answer 15

Athersclerosis, clot, radiation
Chronic: 2 of 3 major vessels occluded, post prandial stomah pain, weight loss, fear of eating (sitophobia), diarrhea
Acute: embolus, severe abd pain

Question 16

Mesenteric Ischemia

diagnx

Answer 16

Fecal fat
CBC, albumin
Vitamin levels
Endoscopy
CT (small bowel, liver, pancreas, bile ducts)

Question 17

SI tumors
(types)

Answer 17

Rarely primary
47% are adenocarcinoma (usually duodenum)
28% carcinoid
13% sarcoma, 12% lymphoma

Question 18

SI tumors (pres/diagnx/treat)

Answer 18

Obstruction symptoms (abd pian, distension, decreased stool output)
Diagnx with biopsy
Treat with resection (unless lymphoma —> chemo)

Question 19

Diarrhea occurs …

Answer 19

when colonic water load exceeds capacity (SEE SLIDES to check)