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JazGI > Small Intestinal pathology > Flashcards

Small Intestinal pathology Flashcards

1
Q

Intestinal failure =

A

inability to maintain adequate nutrition/fluid status via the intestines

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2
Q

Acute intestinal failure lasts up to ___
Type 1 =
Type 2 =

A

2 wks
1= self limiting postop/paralytic ileus => HDU/ITU
2= prolonged and ass. with sepsis and other metabolic complications

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3
Q

Chronic/type 3 cause of intestinal failure =

A

short gut syndrome

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4
Q 
Type 3(chronic) intestinal failure treatment =
UNLESS \_\_\_
A

home parenteral nutrition UNLESS they have cancer too

OR intestinal transplant

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5
Q

Type 1(acute) intestinal failure treatment

A

replace fluids and electrolytes
PPI and octreotide - decrease acid
α-hydroxycholecalciferol - preserves Mg

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6
Q

Type 2 (acute) intestinal failure treatment

A

parenteral by PICC or tunneled catheter/vascuport

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7
Q

Complications of parenteral nutrition

A 
sepsis
SVC thrombus
line fracture/leak/migration
metabolic bone disease
nutrient toxicity/insufficiency
liver disease
metabolic disturbances
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8
Q

Short bowel =

A

less than 200cm of small intestine
inadequate for nutritional needs
diarrhoea and frequent defaecation

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9
Q

If have ___ of small bowel then need HPN

A

less than 50cm

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10
Q

Main indications for intestinal transplant = __+__

A

loss of venous access/liver disease

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11
Q

Ischaemia of the small bowel can be caused by

A

mesenteric artery occlusion
non-occlusion perfusion insufficiency eg. shock/strangulation
hyperviscosity
drugs eg. cocaine = spasms

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12
Q

___ layer of gut wall is most affected by small bowel ischaemia as it is ___

A

mucosal

most metabolically active

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13
Q

Progression of ischaemic small bowel with time:

A 
mucosal infarct (can regen)
mural infarct (regen = fibrous stricture)
transmural infarct (gangrene => death if not removed)
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14
Q

in non-occlusion causes of ischaemic small bowel the damage occurs __

A

after reperfusion

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15
Q

Meckel’s diverticulum =

A

incomplete regression of villeo-intestinal duct 2 ft from IC valve in small intestine

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16
Q

Meckel’s diverticulum may contain ___ which secretes __

bleeding/perforation/diverticulitis may occur and mimics ___

A

gastric mucosa => acid

appendicitis

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17
Q

Primary tumours of the small bowel are rare/common

= (3)

A

lymphoma
carcinoid
carcinoma

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18
Q

Treat lymphomas of the small bowel with ___

They are ___ which are __/__ derived

A

surgery and chemo
non-Hodgkin’s
Maltoma - B cell
enteropathy ass T cell lymphomas - ass. w. coeliacs = high grade and aggressive

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19
Q

Carcinoid tumours in the small bowel are commonest in the ___
Look:
most commonly spreads to __

A

appendix
small, yellow and slow growing. Locally invasive, may cause intusussception/obstruction
liver

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20
Q

Carcinoma of the small bowel is ass with +
identical to ___ in appearance
Present early/late
metastasis to +

A

coeliac’s and Crohn’s
colorectal carcinoma
late
liver and lymph nodes

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21
Q

2ndry cancer of small bowel primary sources =

A

ovary
colon
stomach

22
Q

causes of appendicitis =

A 
unknown
faecoliths due to dehydration
lymphoid hyperplasia
parasites 
tumours (rare)
23
Q

Pathology of appendicitis :

__ inflam w. neutrophils wwhih must involve the ___> mucosal ___ > serosal ___(exudate) > __ in lumen

A

acute involing the muscle coat
ulceration
congestion
pus

24
Q

Coeliac’s =

A

AI

Abnormal T cell reaction to gliadin in gluten => villi atrophy and decreased absorptive capacity

25
Coeliac's is strongly associated with ___ serotype
HLA -B8
26
Strongly associated with dermatitis herpetiformis, TID and hypothyroidism =
Coeliac's
27
T cell response to gliadin in coeliacs causes:
villi atrophy, flat duodenal mucosa | inflammation of the lamina propria
28
Auto-antibodies present in Coeliac's
anti-TTG | ati-endomesial, anti-gliadin
29
Investigations to diagnose Coeliac's
endoscopy duodenal biopsy serology for autoIgs
30
Effects of coeliac's: 1) ____ (of fat =>___) 2) ___ intestinal hormone production => ___ pancreatic secretion and bile flow(CCK) = ___
malabsorption => steatorrhoea | decreased decreased =>gallstones
31
Signs of coeliac's
``` wt loss anaemia abdo bloating FtT vitamin deficiencies ```
32
T cell lymphomas of GI tract are associated with
coeliacs
33
In coelics: gliadin binds to ___ on int. wall which activates ___ > ___ > mucosal lesion
HLA-DQ2/8 T cells cytokines
34
Diagnosis of lactose intolerance is by
lactose breath H+ test OR oral lactose intolerance test
35
Lactose intolerance =
lack of lactase
36
Tropical sprue =
colonisation of intestines by infectious agent/alteration in normal flora
37
treatment of tropical sprue=
tetracycline and folic acid
38
Whipple's disease =
rare, systemic infection by gram +ve Tropheryma Whipplei causes increase in the frequency of HLA B27
39
Signs of Whipple's disease =
arthritis, diarr+steatorrhoea, wt. loss, fever, abdo distension
40
Small bowel bacterial overgrowth of __/__ causes ___ anaemia (lack of __) most common if __/__/__ present in gut
e. coli/bacteroides macrocytic B12 diverticulae/fistulae/strictures
41
Diagnosis off small bowel bacterial overgrowth is by:
low cobalamin (B12) and high folate levels Schilling test: give B12+folate and see if absorb jejunal aspirate and culture
42
Treatment of small bowel bacterial overgrowth
surgical correction of anatomical blind loop | tetracyclines 2-3wks
43
Dermatitis herpetiformis = | due to ___
itchy blisters on extensor surfaces | sub-endothelial IgA deposition
44
borborygmi =
gurgling due to gas or fluid in small intestine
45
Investigations for small bowel obstruction
``` urinalysis ABG bloods AXR contrast CT gastrograffin imaging ```
46
Treatment for adhesional causes of small bowel obstruction
drip and suck (analgesia + fluid + K+ + catheterise + NG tube) anti-thrombotic measures for up to 72 hrs
47
Small intestine/colon has less collaterals and is more prone to necrosis if becomes ischaemic
small intestine
48
Signs of mesenteric ischaemia of the small intestine
pain, acidosis increased lactate small raise in WCC CT angiogram and laparotomy results
49
Treatment of mesenteric ischaemia of small intestine:
quick if non-viable = resect viable = embolectomy
50
Remnant of omphalomesenteric duct
Meckel's diverticulum
51
haematochezia =
passage of fresh blood PR

JazGI (26 decks)

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