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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
Q

Coeliac’s is strongly associated with ___ serotype

A

HLA -B8

26
Q

Strongly associated with dermatitis herpetiformis, TID and hypothyroidism =

A

Coeliac’s

27
Q

T cell response to gliadin in coeliacs causes:

A

villi atrophy, flat duodenal mucosa

inflammation of the lamina propria

28
Q

Auto-antibodies present in Coeliac’s

A

anti-TTG

ati-endomesial, anti-gliadin

29
Q

Investigations to diagnose Coeliac’s

A

endoscopy
duodenal biopsy
serology for autoIgs

30
Q

Effects of coeliac’s:

1) ____ (of fat =>___)
2) ___ intestinal hormone production => ___ pancreatic secretion and bile flow(CCK) = ___

A

malabsorption => steatorrhoea

decreased decreased =>gallstones

31
Q

Signs of coeliac’s

A 
wt loss
anaemia
abdo bloating
FtT
vitamin deficiencies
32
Q

T cell lymphomas of GI tract are associated with

A

coeliacs

33
Q

In coelics:
gliadin binds to ___ on int. wall which activates ___
> ___ > mucosal lesion

A

HLA-DQ2/8
T cells
cytokines

34
Q

Diagnosis of lactose intolerance is by

A

lactose breath H+ test
OR
oral lactose intolerance test

35
Q

Lactose intolerance =

A

lack of lactase

36
Q

Tropical sprue =

A

colonisation of intestines by infectious agent/alteration in normal flora

37
Q

treatment of tropical sprue=

A

tetracycline and folic acid

38
Q

Whipple’s disease =

A

rare, systemic infection by gram +ve Tropheryma Whipplei causes increase in the frequency of HLA B27

39
Q

Signs of Whipple’s disease =

A

arthritis, diarr+steatorrhoea, wt. loss, fever, abdo distension

40
Q

Small bowel bacterial overgrowth of __/__ causes ___ anaemia (lack of __)
most common if __/__/__ present in gut

A

e. coli/bacteroides
macrocytic B12
diverticulae/fistulae/strictures

41
Q

Diagnosis off small bowel bacterial overgrowth is by:

A

low cobalamin (B12) and high folate levels
Schilling test: give B12+folate and see if absorb
jejunal aspirate and culture

42
Q

Treatment of small bowel bacterial overgrowth

A

surgical correction of anatomical blind loop

tetracyclines 2-3wks

43
Q

Dermatitis herpetiformis =

due to ___

A

itchy blisters on extensor surfaces

sub-endothelial IgA deposition

44
Q

borborygmi =

A

gurgling due to gas or fluid in small intestine

45
Q

Investigations for small bowel obstruction

A 
urinalysis
ABG
bloods
AXR
contrast CT
gastrograffin imaging
46
Q

Treatment for adhesional causes of small bowel obstruction

A

drip and suck (analgesia + fluid + K+ + catheterise + NG tube)
anti-thrombotic measures
for up to 72 hrs

47
Q

Small intestine/colon has less collaterals and is more prone to necrosis if becomes ischaemic

A

small intestine

48
Q

Signs of mesenteric ischaemia of the small intestine

A

pain, acidosis
increased lactate
small raise in WCC
CT angiogram and laparotomy results

49
Q

Treatment of mesenteric ischaemia of small intestine:

A

quick
if non-viable = resect
viable = embolectomy

50
Q

Remnant of omphalomesenteric duct

A

Meckel’s diverticulum

51
Q

haematochezia =

A

passage of fresh blood PR

JazGI (26 decks)

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