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Hannah MS2 GI > small intestine > Flashcards

small intestine Flashcards

1
Q

complications of refractory celiac dz despite gluten free diet

A

t cell lymphoma

SI adenocarcinoma

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2
Q

biological causes of malabsorption in viral, bacterial and parasitic gastroenteritis

A

terminal digestion and transepithelial transport

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3
Q

describe the pathogenesis of adhesions

A
  • MC type of intestinal obstruction in the US
  • peritoneal inflammation (congenital or acquired from surgery/trauma)–> adhesions/fibrous bridges–> entrapped viscera (internal herniation) –> obstruction , strangulation
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4
Q

complications of external herniation (visceral protrusion of GI tract )

A

incarceration, strangulation, and infarction

-impaired venous return–>stasis/edema–> enlarged hernia, permanent entrapment (incarceration) –> arterial/venous compromise (strangulation) –> infarction

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5
Q

what pathology is associated with lipid accumulation seen with red-o oil stain

A

abetalipoprotienima

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6
Q

biological causes of malabsorption in acetalipoproteinemia

A

transepithelial transport

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7
Q

biological causes of malabsorption in chronic pancreatitis, and cystic fibrosis

A

intraluminal digestion

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8
Q

AR DO presents in infants with inability to secrete triglyceride rice lipoproteins (APOB 48 and APOB 100) due to MTP mutation

A

abetalipoprotienima

  • APOB48 makes chylomicrons
  • APOB100 makes LDL VLDL
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9
Q

most common presentation of malabsorption

A

chronic diarrhea

others: wt loss, distention, borborygmi (rumbling), muscle wasting, steatorrhea

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10
Q

congenital lactase deficiency vs acquired

A

congenital: (rare) AR DO with explosive osmotic watery diarrhea, frothy stools, ab distention all on consumption of milk
acquired: decrease regulation of lactase gene common in native americans, african americans, chinese/ sx: ab fullness, osmotic diarrhea, gas on consumption of dairy
* may be TEMPORARY kind following infections with similar symptoms

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11
Q

4 types of diarrhea

A
  1. secretory - isotonic stool; persistent with fast
  2. osmotic- osm gap; decrease with fast
  3. malabsorptive- steatorrhea; decrease with fast
  4. exudative - purulent, bloody, persistent with fast
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12
Q

telescoping of proximal segment of bowel forward to distal segment associated with leading edge

A

intusseception

-can lead to obstruction and infarction

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13
Q

common causes and clinical manifestation of intestinal obstruction

A

common causes: hernias, adhesions, intussusception, volvulus
-clin man: ab pain, distension, vommitting, constipation

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14
Q

grows as a submucosal polyp like nodule and secretes serotonin in urine

A

midgut carcinoid tumor (jejunum/ileum)

  • healthy liver = 5HIAA in urine and no carcinoid syndrome, heart disease
  • liver metastais = bypass liver and serotonin is systemic causing right heart disease (R valve collagen/fibrosis –> PS or TR) and carcinoid syndrome (flushing, diarrhea, bronchospasm)
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15
Q

IPEX -X linked DO; causing FoxP3 mutation of CD4 T-reg cells resulting in antibodies to enterocyte goblet cells, parietal cells, or islet cells
*sx: severe persistent diarrhea and AI dz in young children

A

autoimmune enteropathy

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16
Q

biological causes of malabsorption in lactose def

A

terminal digestion

17
Q

gross and histo of carcinoid tumor

A

gross: yellow/tan
histo: “salt n pepper” cytology
- dense core with neurosecreotry granules on EM (chromogranin A positive if midgut)

18
Q

pathogenesis of celiac disease

A

deaminated gliadin by tissue transglutaminase (tTG) is presented to CD4+ T helper cells via MHC II; the T cells imitate damage

19
Q

what is the most common cause of intussecpition in adults

A

tumor or mass

20
Q

4 main biological causes of malabsorption

A
  1. defect intraluminal digestion
  2. defect terminal digestion
  3. defect transepithelial transport
  4. defect lymphatic transport of lipids
21
Q

t/f

because lactase deficiency defect is biochemical a biopsy of the brush border will be normal

A

true

-where lactose is normally located

22
Q

3 variables of severity of SI infarction

A
  1. duration
  2. artery associated
  3. severity of compromise
23
Q

lab findings of celiac dz

A

IgA ab vs endymysion, tTG, and gliadin

*if IgA def then it is IgG type

24
Q

what is the most common cause of intestinal obstruction in children under the age of 2 yo

A

intusseception

-due to lymphoid (peters patch) hyperplasia due to rotavirus infection at the terminal ileum –> cecum

25
Q

biosy findings of celiac dz

A

flat vili, crypt hyperplasia, CD8 intraepithelial lymphocytes

*immune mediated damage of SI villi (most commonly the DUODENUM)

26
Q

cause of a transmural vs mucosal SI infarct and associated sx

A

transmural- hypercoaguble state and thromboembolism of the SMA or thrombosis of mesenteric vein

mucosal- marked hypotension (possibly shock)

sx: ab pain, BLOODY diarrhea, decreased bowel sounds (paralytic ileus- might need surgery)

27
Q

average size of midgut carcinoid tumor and what are it secretions

A

<3.5cm (but aggressive)

-secrete: serotonin, Substance P, and PYY

28
Q

biological causes of malabsorption in celiac dz

A

transepithelial transport and terminal digestion

29
Q

carcinoid tumor causes _____ if liver metastasis

A

chronic diarrhea

30
Q

twisting of the bowel about its mesentery

A

volvulus

-can lead to obstruction and infarction

31
Q

most common site of volvulus

A

elderly - sigmoid colon

young adult - cecum

32
Q

extra GI sx of celiac dz

A

dermatitis herpetiformis, iron def anemia, apthous ulcers, short state,

33
Q

MCC of malabsorption in the US

A
  1. pancreatic insufficiency
  2. celiac DZ
  3. Crohns (IBD)
34
Q

neurosecretory granules in midgut carcinoid tumor are ______ positive

A

Chromogranin A + tumor cells

35
Q

biological causes of malabsorption in whipple disease

A

lymphatic transport

36
Q

sx of abetalipoprotienima

A

FTT, diarrhea, malabsorption, steatorrhea, absent plasma lipoproteins (VLDL and LDL)
-fat vitamin def = membrane defects seen as acanthocythic RED cells (BURR CELLs) seen on peripheral blood smear

37
Q

biological causes of malabsorption in Crohns

A

intraluminal digestion, terminal digestion, transpithelial transport

Hannah MS2 GI (10 decks)

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