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small intestine Flashcards

1
Q

causes for duodenal ulcers

A

H. pylori (90%)

Zollinger-Ellison Syndrome (gastrinoma in pancreas): consider if RECURRENT after tx with PPI, check gastrin level

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2
Q

BILIOUS vomiting

“double bubble sign”

A 
duodenal atresia (no canalazation of duodenum = blind pouch)
distention of stomach in front of pylorus + distention of duodenum pouch
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3
Q

associated with duodenal atresia

A

down syndrome

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4
Q

imaging evaluation of patient with jaundice

A

endoscopic retrograde cholangiopancreatogram (ERCP)

esophagus → stomach → duodeunum → inject dye in ampulla of vater → visualize biliary tree + pancreatic duct

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5
Q

located in duodenal submucosa

A

brunner gland

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6
Q

hypertrophied with duodenal ulcers

A

brunner glands

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7
Q

prokinetic agents

A

↑Ach (parasympathetic), ↑5HT (carcinoid syndrome - produces vasoactive amines), ↓D2
cholinergic agoinst (bethanechol)
acetylcholinesterase inhibitors (neostigmine)
metoclopromide: stimulate 5HT4, inhibit D2
macrolide: stimulate smooth muscle motilin receptors

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8
Q

no peristalsis - blood diverted to more important areas of body

cause: post-op, stroke, septic shock, ICU
treatment: prokinetic agents

A

intestinal ileus

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9
Q

↑ 5HT causes

A

diarrhea (seen in carcinoid syndrome)

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10
Q

enterocyte characteristics

A

villi: absorption

secrete digestive enzymes

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11
Q

Crypts of Lieberkuhn

A

between villi of enterocytes

glands that secrete digestive enzymes

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12
Q

iron absorption

A

duodenum

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13
Q

folate absorption

A

duodenum + jejunum

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14
Q

B12 absorption

A

terminal ileum

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15
Q

iron deficiency anemia due to malabsorption

A

antacids, some antibiotics (quinolones, tetracycline): iron absorption occurs in acidic environment
gastric bypass surgery: bypass duodenum

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16
Q

causes of folate deficiency

A

poor nutrition: alcoholism

infant fed exclusively goat’s milk

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17
Q

infant fed exclusively with goat’s milk

A

folate deficiency

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18
Q

cause of B12 deficiency (megaloblastic anemia)

A

no terminal ileum
malnutrition
↓ absorption in terminal ileum
pernicious anemia: autoimmune destruction of gastric parietal cells (no IF)

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19
Q

AR
lack of apo-B leading to defective chylomicron assembly → chylomicron doesn’t leave enterocyte → enterocytes stop fat absorption

A

abetalipoproteinemia

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20
Q

apo-B48 is marker on chylomicrons

A

allows chylomicron to leave enterocyte

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21
Q

steatorrhea (malabsorption of ADEK) failure to thrive (first few months of life)
ataxia
acanthocytes: star RBCs

A

abetalipoproteinemia

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22
Q

disaccharidase deficiency
lactase breaks lactose → glucose + galactose
when not broken down: lactose is metabolized by bacteria in colon → fermentation →
bloating
cramping
diarrhea

A

lactase deficiency

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23
Q

lactase located in tips of microvilli - can be damaged in

A

gastroenteritis - blunts microvilli

temporary lactase deficiency

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24
Q

likely infectious cause

affects ENTIRE small intestine (vs celiac disease only in proximal small bowel)

A

tropical sprue

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25
Q

complications of tropical sprue

A

vitamin deficiencies

megaloblastic anemia

26
Q

treatment of tropical sprue

A

antibiotics (doesn’t improve with gluten-free diet)

27
Q

caused by tropheryma whipplei (G+)

A

whipple disease

28
Q 
older white male:
weight loss
diarrhea
fever
LAD
hyperpigmentation
cardiac sx
arthritis
neruo sx
A

whipple disease

29
Q

PAS + foamy macrophages in intestinal lamina propria

A

whipple disease (t. whipplei inside macrophages)

30
Q

treatment of whipple disease

A

penicillin, ampicillin, tetracycline

1-2 year long

31
Q 
nausea
bloating
vomiting
diarrhea
malabsorption
aspirate of jejunum: excessive bacterial growth
A

bacterial overgrowth of small intestine

32
Q

risk factor for bacterial overgrowth

A 
dysmotility
fistula
diverticula
illeocecal valve resection
gastroenteritis
PPIs
33
Q 
complication of:
chronic pancreatitis
cystic fibrosis
gallstones
cancer
A

pancreatic insufficiency

34
Q

steatorrhea (fat malabsorption - ADEK vitamines)

A

pancreatic insufficiency

35
Q

small intestinal mucosa laden with distended macrophages in lamina propria

A

whipple disease

36
Q

defect in chylomicron exportation

A

abetalipoproteinemia

37
Q

chronic abdominal pain + altered bowel habits
ab pain: crampy, variable intensity, IMPROVES with defecation
bowel habits: diarrhea, constipation, alternating diarrhea and constipation
other GI sx: GERD, dysphagia, early satiety, nausea, chest pain
non-GI sx: urinary frequency/urgency, dysmenorrhea, dsypareunia, fibromyalgia (depression too)

A

irritable bowel syndrome

38
Q

symptoms NOT associated with IBS!!

A 
rectal bleeding
nocturnal ab pain
weight loss
anemia
elevated inflammatory markers
electrolyte abnormalities
39
Q

treatment of IBS

A 
avoid lactose or gluten
fiber supplement
antispasmodics: dicyclomine, hyoscyamine
antidepressants: TCA, SSRI
guanylate cyclase agonist: IBS with constipation
40
Q

most common congenital anomoly in GI tract

A

Meckel diverticulum

41
Q

incomplete obliteration vitelline duct

A

Meckel diverticulum

42
Q
A

Meckel diverticulum

43
Q

diagnosis of Meckel diverticulum

A

Meckel scan: look for ectopic gastric mucosa (pancreatic epithelium may also be present)

44
Q

most common abdominal emergency in kids

A

intussusception

45
Q

telescoping of bowel into DISTAL segment (near ileocecal junction - small bowel into cecum)

A

intussusception

46
Q

complications of:
adenovirus
Meckel diverticulum

A

intussusception (but usually idiopathic)

47
Q

“currant jelly” stool

A

intussusception (bloody stool)

48
Q

“bulls-eye” or “coil spring” on US

A

intussusception

49
Q

common causes of small bowel obstruction

A 
ABC
Adhesions: surgical adhesions from previous surgery (75%)
Bulge: hernia (second most common - inguinal hernia incarcerated (can't reduce) → infarction/strangulation)
Cancer: tumors (metastatic colorectal cancer most common)
less common:
volvulus
intussusception
chron's disease
gallstone - obstructs lumen of SB
ileus
bezoar
bowel wall hematoma from trauma
inflammatory stricture
congenital malformation
radiation enteritis
50
Q

dilated bowel on ab xray

A

small bowel obstruction

gas builds up

51
Q

> 3 days to pass meconium

A

meconium ileus

52
Q

normal time that meconium is passed

A

within 3 days of birth

53
Q

causes of meconium ileus

A

cystic fibrosis

hirschsprung disease

54
Q 
premature infant that received oral feeds too soon: bowel undergoes 
feeding intolerance
↑gastric residuals
ab distention
bloody stools
perforation
A

necrotizing enterocolitis

55
Q

abdominal xray shows:
dilated loops of bowel
paucity of gas
pneumatosis intestinalis (presence of gas in wall of intestine)

A

necrotizing enterocolitis

56
Q

treatment of necrotizing enterocolitis

A

bowel rest by giving parental nutrition (IV food)

57
Q

↓ blood flow to part of bowel
associated with atherosclerosis of celiac or mesentaric arteries
splenic flexure (watershed) is susceptible to injury
distal colon too

A

ischemic colitis

58
Q

elderly
pain out of proportion to physical exam (no signs of appendicitis, cholecystitis)
WORSE with eating
weight loss

A

ischemic colitis

59
Q

small vascular malformation in gut → bleed easily
common in elderly
usually cecum or ascending colon
unexplained GI bleeding + anemia
dx: colonoscopy to see bleeding, angiography will better show bleeding

A

angiodysplasia

60
Q

neuroendocrine tumor that secretes SEROTONIN in appendix, ileum, rectum and lung

A

carcinoid syndrome

61
Q 
BFDR
Bronchospasm
Flushing
Diarrhea
Right sided murmur (deposits in R sided valves) + edema, ascites (all = Right sided heart disease)
A

carcinoid syndrome: cause by excess serotonin from carcinoid tumor

*symptoms only if tumor is outside of GI tract because liver metabolizes all the 5HT produced in colon (carcinoid tumor mets outside of GI or started in lung)

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