Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > Small Intestine > Flashcards

Small Intestine Flashcards

1
Q

Celiac Dz

Whipple Dz

Tropical Sprue

Lactose Deficiency

Bacterial Overgrowth

Short bowel syndrome

A

Malabsorption syndorme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

IRON

Calcium

Copper

Magnesium

Phosphorus

Riboflavin

Thiamin

A

Absorbed in Duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Vitamins ADEK

Folate

A

Jejunum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Vit B12

Bile salts/acids

A

Ileum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the BIG THREE clinical manifestations of malabsorption?

A

Steatorrhea

Microcytic/macrocytic anemia

Dairy intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bulky, greasy stools that typically float

Sign of increased fat

A

Steatorrhea (sign of malabsorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lab = low serum iron

A

Microcytic anemia (malabsorption sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lab = low B12, low folate

A

Macrocytic anemia (malabsorption sign)

Consider tropical sprue OR bacterial overgrowth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Typical symptoms: weight loss, chronic diarrhea, abdominal distention, growth
retardation.

Atypical symptoms: dermatitis herpetiformis, iron deficiency anemia, osteoporosis.

Abnormal serologic test results. Abnormal small bowel biopsy.

Clinical improvement on gluten-free diet.

A

Celiac dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diffuse damage to the proximal small intestine

A

Celiac dz

Immunological response to gluten

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Usually diagnosed in late childhood/early adulthood

Grossly underdiagnosed

A

Celiac disease

(1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most important step is to consider the diagnosis

SSx are variable for Celiac (Depends on small intestine into element). What are the classic symptoms?

A

Dyspepsia

Diarrhea

Steatorrhea

Wt loss

Flatulence/abd distention/bloating

Borborygmi

(Weakness/muscle wasting if severe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Many adults may present asymptomatically/atypically w/ with what ssx?

“Extraintestinal manifestations”

A

Fatigue

Depression

Iron deficiency anemia

Osteoporosis

Transaminitis

Dermatitis herpetiforims

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Regarded as a cutaneous variant of celiac dz

Skin rash w/pruritic papulovesicles over the extensor surfaces

A

Dermatitis herpetiformis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most cases of Celiac dz are unremarkable on PE

However, nutrient deficiencies maybe present due to malabsorption , such as?

A

Loss of muscles mass, bruising (due to def. in. Vit K), hyperkeratosis (Vit A def.), bone pain, neuro deficit is (def. in Vit B)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Labs (such as CBC/CMP/UA) may produce non specific results … What’s the test of choice for Celiiac?

A

IgA trans glutaminase (IgA tTG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If IgA tTG is negative for celiac, but still a strong clinical suspicion for celiac.. what’s your next move?

A

Obtain serum IgA levels

Then do an anti-DGP test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If a patient has IgA deficiency what Follow up test could be performed to asses for celiac?

A

Deamidated gliadin peptides(anti-DGP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Confirmatory test in pts w/ a Celiac positive serological test?

A

Endoscopic mucosal biopsy of proximal/distal duodenum

Normal biopsy excludes Celiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Histology exam reveals blunting and/or atrophy of the intestinal villi

(Near absence of villi = flat mucosa)

A

Celiac

Biopsy after pos serology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Diff Dx for celiac?

A

IBS

chronic diarrhea

Tropical sprue

Lactose intolerance

Gastroenteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnostic approach to Celiac…

Diagnostic suspicion… Serologic testing… trial of gluten free diet…

Mucosal biopsy

A

Celiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tx of Celiac?

A

Removal of all gluten products including oats

Should see improvement in 2-3 weeks…

(REFER TO DIETICIAN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most common reason for tx failure in celiac?

W/ celaic, Any risk for cnacer?

A

Most common reason for failure is dietary noncompliance

SLIGHT increase in risk for adenocarcinoma and lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

No need for retesting if dietary measures are effective… However…

A

If symptoms persist, refer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Multisystem dz

Fever/lymphadenopathy/arthralgias

Wt loss

Duodenal biopsy w/ Periodic Acid Schiff (PAS) positive macrophages w/ bacillus

A

Whipple Dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

In whom is whipple dz most common?

How’s it spreads?

A

Most common in white males, age 30-50

No human-human spread.. Contact w/ sewage/waste water

Fatal if untreated

White males 30 -50
Waste Water
With human to human (fecal)
With migrating arthralgia *first sign if present*
WEIGHT LOSS - MOST common*
With fever
With lymphadenopathy
Whippelii trophoryme
WILL KILL YA!
Will DIAGNOSE with EGD and find "foamy macrophages"
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Common/class presentation of Whipple?

A

**MIGRATORY arthralgias - first sign

Diarrhea

Abd pn

Wt loss - MOST COMMON

FEVER OF UNKNOWN ORIGIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Less common signs… What diseas?

Skin hyperpigmentation

Generaliazed lymphadenopathy

Ophthalmoplegia

A

Whipple dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Diagnosis of Whipple dz is usually performed how?

A

Endoscopic biopsy w/ evidence of bacterium

“Foamy macrophages”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

TX for whipple dz?

A

IV ceftriaxone for 2 weeks

THEN

TMP-SMX 1 tab PO BID for ONE YEAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Environmental enteropathy

Occurs in narrow Tropical band

Chronic diarrhea (often after acute diarrhea)

Involves entire small intestine

CHaracterized by malabsorption (esp folic acid//B12)

A

Tropical sprure

Tropical malabsopriton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Chronic diarrhea

Steatorrhea

Wt loss

Malaise

B12/Folate deficiency (glossitis/cheilitis)

A

tropical sprue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

CBC would show megaloblastic anemia

Endoscopy w/ biopsy would show flattened duodenal folds

A

Tropical sprue

Microscopic findings of blunted villi and ELONGATED CRYPTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Prevention of tropical sprue?

Tx?

A

Prevention : boiled/bottled water; peel fruits

Tx: TMP-SMX x 6 mos; folate/B12 supps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Diarrhea, bloating, flatulence, and abdominal pain after ingestion of milk-
containing products.

Diagnosis supported by symptomatic improvement on lactose-free diet.

Diagnosis confirmed by hydrogen breath test.

A

LactAse deficiency

37
Q

BRush border enzyme that hydrolysis lactose in glucose and galactose

A

Lactase deficiency

38
Q

Malabsrobed lactose is fermented by intestinal bacteria producing gas and organic acids

A

Cool

LactAse deficiency

39
Q

Top three lactase deficient populations?

A

Asian (95-100%)

American Indians (80-100%)

Black people (60-80)

40
Q

Ssx of lactose are variable and dose dependent…

  1. Small intake?
  2. Mod intake?
  3. Large intake?
A
  1. Maybe asymptomatic
  2. Bloating, cramps, flatulence
  3. OSMOTIC DIARRHEA
41
Q

Other signs of malabsorption SHOULD NOT be present in lactase deficiency… so if wt loss is present then what?

A

LOOKK FOR ANOTHER ETIOLOGY

42
Q

Tx for Lactase deficiency

Presumptive diagnosis of lactase deficiency?

Diagnostic test for lactase deficiency?

A

Presumptive -> 2-3 week of lactose free diet

Diagnostic test = hydrogen test

43
Q

Symptoms of distention, flatulence, diarrhea, and weight loss.
Increased qualitative or quantitative fecal fat.

Advanced cases associated with deficiencies of iron or vitamins A, D, and B12.

Diagnosis suggested by breath tests using glucose, lactulose, or 14C-xylose as
substrates.

Diagnosis confirmed by jejunal aspiration with quantitative bacterial cultures.

A

Bacterial overgrwoth

44
Q

Consider what dz in these following pts:

Pts on chronic PPI

Pts who have an anatomical abnormality Or motility disorder of small intestine

Pts who have gastrocolic/coloenteric fistula (e.g., Crohn, malignancy, surgical resection)

A

Bacterial overgrwoth

45
Q

Bacterial overgrwoth is an important cause of malabsorption in what pt population?

A

Olds

46
Q

Bacterial overgrowth can often be a symptomatic… What would be the ssx?

A

Flatulence

Wt loss

Abd pn

Diarrhea

Steatorrhea

Macrocytic anemia

47
Q

Specific diagnosis for bacterial overgrowth can be establish by aspirate and culture (but this is expensive and difficult) So what do we use?

A

Can use a noninvasive breath test but many clinicians use an empiric approach w/ abx

48
Q

Thx for bacterial overgrwoth?

A

Empiric tx w/ antibiotics… Cipro, Amoxicllin-clavulanate, Rifaximin

49
Q

Short bowel syndrome

Due to removal of significant segments of small intestine

What does the degree of malabsorption depend on?

A

Length

Site

Degree of adaptation of remaining bowel

50
Q

Precipitating factors: surgery, peritonitis, electrolyte abnormalities, medications,
severe medical illness.

Nausea, vomiting, obstipation, distention.

Minimal abdominal tenderness; decreased bowel sounds.

Plain abdominal radiography with gas and fluid distention in small and large
bowel.

A

Acute paralytic ileus

51
Q

Types of intestinal motility disorders?

A

Acute paralytic ileus

Chronic intestinal pseudo-obstruction

Small bowel obsutrcion

52
Q

Ileus considered in hospitalized pts as results of?

A
  1. Intrabdominal processes (surgery/peritoneal irritation)
  2. Severe medical illness (pneumonia, respiratory failure, etc.)
  3. Medications that affect motility (opioids, anticholinergics, phenothiazines)
53
Q

Failure or loss of intestinal peristalsis WITHOUT mechanical obstruction

A

Acute paralytic ileus

54
Q

Diffuse, CONSTANT abd pn

Nausea and vomiting

LACK OF ABDOMINAL TTP (no signs of peritoneal irritation)

Abdominal distension

Diminished/absent bowel sounds

A

Acute paralytic ileus

55
Q

Though lab findings in acute paralytic ileus are non-specific, they should be obtained why?

A

To exclude abnormalities as contributing factors

56
Q

What would you see on a X-ray of acute paralytic ileus?

A

Gas-filled loops of the small/large intestine (air fluid levels may be present)

57
Q

Ilues must be distinguished from mechanical obstruction. How might you tell

A

Pain from obstruction is typically intermittent w/ cramping and profuse vomiting.

Ileus is CONSTANT

58
Q

Treatment for acute paralytic ileus?

A

Tx underlying dz

Pn mgmt/fluid maintenance/electrolyte replacement

Nasogastric decompression for severe distension

59
Q

Severe abdominal distention.

Arises in postoperative state or with severe medical illness.

May be precipitated by electrolyte imbalances, medications.

Absent to mild abdominal pain; minimal tenderness.

Massive dilation of cecum or right colon.

A

Acute Colonic pseudo-obstruction (Ogilvie syndrome)

60
Q

Similar to gastroparesis

Intermittent signs of obstruction in the absence of a physical obstruction

A

Chronic intestinal pseudo obstruction

61
Q

Involvement of the small bowel results in….

Abd distension

Vomiting

Diarrhea

Varying degrees of malutrition

A

Chronic intestinal pseudo obstruciton

62
Q

In a work up of chronic intestinal pseudo obstruciton, what must you exclude? With what type of imaging?

A

Exclude mechanical obstruction with CT or endoscopy

63
Q

Tx for chronic intestinal pseudo obstruciton?

A

Acute exacerbation require NG decompression and IV fluid/electrolyte replacement

Refer to GI

64
Q

What are most small bowel obstructions attributed to?

A

Postop adhesions or hernias

(Other causes include neoplasm, strictures, foreign body , intussusception, gallstones

65
Q

Prior abd/ pelvic surgery

Abd/groin hernia

Intestinal inflmmation

Hx of neoplasm

Prior radiation

Hx of foreign body ingestion

A

RISK factors for SBO

66
Q

How would a SBO clinically present?

A

ABRUPT onset of:

COLICKY pn

Nausea

Profuse vomiting

Obstipation

67
Q

PE findings for SBO?

A

Abd distension (tympany)

HYPERactive bowel sounds early, then progress to HYPOactive later

Signs of dehyration

68
Q

Labs for SBO include CBC, CMP, Urinalysis, and what?

If surgery is indicated?

A

Type and cross match for surgery

69
Q

What type of radiographs for SBO?

What do you expect to see?

A

Plain abdominal films…

Upright and supine…

DILATED LOOPS OF SMALL BOWEL W/ AIR FLUID LEVELS

70
Q

When should you perform a CT scan for a suspected SBO/?

A

If pat has fever, tachy, localized abd pn, or leukocytosis

To dx a strangulated obstruciton

71
Q

Thx for SBO?

A

Early surgical consultation

ADMISSION

Flui resuscitation

Bowel decompression w/ NG

Pain control

Antiemetic meds

72
Q

Complications of SBO?

A

Dilation -> comprised intramural vessels -> ischemia -> necrosis

73
Q

Rare

Due to impaction of gallstone in the ileum after passing through fistula

Common in whom?

A

Gallstone ileus, more common in females/older patients

Female/Fat/Forty/Fertile

74
Q

Segment of intestine invaginates into adjoining intestinal lumen…

Common in whom and what’s the stool look like?

A

Intussusception more common in kids and causes currant jelly stool

75
Q

Though rare, primary malignancy of the small bowel can cause what?

A

Intussusception (obstruciton)

76
Q

If small intestinal, Adenocarcinoma are most commonly in the Duodenum or proximal jejunum. How would it present?

A

Obstruciton, chronic GI bleed, wt loss

77
Q

What populations have increased incidents of small intestinal lymphomas?

A

AIDS/immunosuppressed, Crohn dz

Side Note: Small intestinal Neoplasms - mainly adenocarcinoma and lymphomas*

78
Q

Intestinal carcinoid,

Sarcoma

A

Small intestinal neoplasm possibilites

79
Q

Usually a result of an already established GI order

Causes excess loss of serum protein into GI tract (hypoalbuminemia)

A

Protein losing enteropathy

80
Q

Thx of protein losing enteropathy?

A

treat underlying condition

Dietary therapy and if severe, albumin replacemtn

81
Q

Interruption of blood to the bowel

Acute arterial occlusion (emboli or thrombotic)

Non-occlusive -> vasospasm, low cardiac output

Ischemia -> necrosis (emergency)

A

Mesenteric ischemia

82
Q

Classically… pain out of proportion w/ PE

DIagnose w/ CT angiography

A

Mesenteric ischemia

83
Q

Tx for mesenteric ischemia?

A

Admit!

Papaverine (smooth muscle relaxant)

Thrombolytics

Surgical referral

84
Q

Most common CONGENITAL abnormality of the GI tract?

Rule of twos….

A

Meckel’s diverticlum

2% of population.

2:1 male to female

2 feet of ileocecal valve

2 types of mucosa

SSx before age 2

Males 2:1
Manifests 2/yo (although under 10 y/o and adults less than 40 must suspect for different reasons)
Maybe 2% of pop
Most 2' w/i ileocecal valve
2 types of mucosa
85
Q

Variable presentation… but can see

GI bleeding

Abd Pain (similar to appendicitis)

A

Meckel’s diverticula

86
Q

Suspect Meckel’s in whom?

A

Children under 10 who present w painless GI bleeding w/o ssx of gastroenteritis or IBD

Adult pts less than 40 w GI bleeding but ID’ed source on endoscopy

87
Q

How to diagnose Meckel’s?

A

Capsule endoscopy

Meckel’s scan (nuke medciine w/ 99m technetium)

88
Q

Tx for Meckel’s?

A

Referral for surgical eval if ASYMPTOMATIC

Symptomatic? Stabilize bleed and removal diverticula

89
Q

pruritic papulovesicles or rash that appears as:
Extremely itchy bumps or blisters appear on both sides of the body, most often on the forearms near the elbows, as well as on knees and buttocks, and along the hairline.

A

Dermatitis herpetiformis

GI (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions