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Path 2 > Small Intestine and colon Part 1 > Flashcards

Small Intestine and colon Part 1 Flashcards

1
Q

What causes the obstruction os the small intestine

A

80% are Lesions hernias, intestinal adhesion, intussusception and volvulus

10 to 15% are tumors, infraction and other causes of strictures, Crohn Disease

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2
Q

What are the manifestations of Intestinal Obstruction

A

Abdominal Pain and discomfort and vomiting and constipations

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3
Q

What is the mechanism of Intestinal Obstruction

A

Normal flow of intestinal contents is disrupted - proximal dilation + distal decompression

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4
Q

What are the complication of Intestinal obstructions

A

Bowel ischemia due to bloody supply being strangulated, inflammation leads to venous congestion, edema and distortion or normal bowel absorptive function - increased intraluminal fluid. Transudative fluid loss ( hypovolemia into peritoneal cavity, electrolyte disturbance
Shock
Perforation

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5
Q

What is the presentation of Small bowel Obstruction

A 
Nausea and vomiting early 
Abdominal pain that comes and goes 
distension occurs 
constipation occurs 
Bowel sounds increased 
in X-ray the is an increase in air  fluid levels
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6
Q

What is the presentation in Large Bowel Obstruction

A 
Nausea and vomiting late 
Abdominal pain that comes and goes 
distension occurs 
constipation occurs
Bowel sounds increased 
in X-ray the is an increase in air  fluid levels
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7
Q

What is the prestantion of Pseudo-Obstruction

A 
Nausea and vomiting occurs 
Abdominal pain is minimal 
distension occurs 
constipation occurs 
Bowel sounds decrease 
in X-ray the is an increase in air
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8
Q

What are the causes of small bowel obstruction

A 
S - stricture 
H - hernia - 2nd cause 
A- adhesion - MCC
V -volvulus 
I - intussception
N - Neoplasm 3rd cause 
G - Gallstones
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9
Q

What are the causes of large bowel obstruction

A

Cancer
Diverticulitis
Volvulus

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10
Q

What is adhesions

A

Fibrous Band that forms between tissues Natural part the body’s healing process after surgery, similar to how a scar forms. Adhesion extend from within one tissue across to another, usually across a virtual space such as the peritoneal cavity. adhesion formation post surgery typically occurs when 2 injured surfaces are close to one another. this often cause inflammation and cause fibrin deposition onto the damage tissues.

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11
Q

What is a hernia

A

Defect in fascia - protrusion of bowel into sac. Males are more likely than females. Most common is the indirect (50%).

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12
Q

What is the Progression of the Hernia?

A

Entrapment, Incarceration, Strangulation ( Blood supply to the part of the bowel is blocked) and Infarction

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13
Q

What are the risk factors of hernia

A 
Chronic Cough
Pregnancy 
Constipation 
Obesity
Ascites 
Straining 
Hernia repair 
Heavy lifting
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14
Q

What are the features of Hernia

A

Bulging with the patients coughs, sits ups and goes away when the patient is upon or when reduces
REMEMBER MD’s don’t lie

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15
Q

What is Volvulus? What is the most common area

A

Rotation of a segment of bowel about its mesenteric axis.

Sigmoid Colon due to the shape

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16
Q

What is intussusception

A

Part of bowel folds into another section of bowel ( telescoping) Mostly seen in the Kids: M>F

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17
Q

What are the complications of Intussusception

A

Obstruction, infarction and necrosis

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18
Q

What are the clues of intussusception

A

Sausage shaped Palpable mass

Rectal Bleeding

Kids Crises and draws knees up to chest

DONUT!!!!! or Target sign!!!

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19
Q

What is a major of Intussusception

A

There may be HSP or Henoch-Scholein Purpura. This is mainly in kids that follows an upper respiratory infection. there may be vasculitis, purport on buttock and legs, along with abdominal pain and Arthritis.

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20
Q

What is colonic Pseudo-Obstruction and what are the types

A

Symptoms similar to intestinal blockage but no physical signs of blockage.

Paralytic ileus and Ogilvie’s syndrome

21
Q

What is paralytic ileus?

A

Temporary paralysis of myeneteic plexus. tends to occur in postoperative surgeries and medications

22
Q

What is ogilivie syndrome

A

Acute pseudo obstruction. tends to happen in bedridden patients that have a serious extra intestinal illness like trauma, infection and cardiac

23
Q

What is ischemic bowel disease

A

is a medical condition in which injury of the small intestine occurs due to not enough blood happens in the splenic flexure or the watershed region

24
Q

What are the causes of ischemic bowel disease

A 
Clots 
Atrial Fibrillations 
DVT 
Cardiac Vegetation 
Malignancy 
Low Perfusion/ Hemorrhage 
CHF
Shock 
Dehydration 
Vasoconstriction drugs
25
Q

What are the signs of Ischemic Bowel Disease

A

Sudden severe left sided abdominal pain and bloody stools

26
Q

What is Necrotizing Enterocolitis

A

blood vessels have not completely developed. leads to bowel necrosis. That happens in premature infants

27
Q

What is the sign and symptoms Necrotizing Enterocolitis

A

Poor feeding
Abdominal distension
Bloody stools

28
Q

What is angiodysplasia

A

Vascular malformation of the gut that is present in older patients. the MCL is the cecum and ascending colon. It is the 2nd MCC of lower GI bleeding.

29
Q

What is the MCC of Angiodysplasia

A

DIVERTICULOSIS

30
Q

What is the associated angiodysplasia

A

aortic stenosis. vWF gets damaged due to high stress at the aortic valve and it leads to bleeding

31
Q

What are hemorrhoids

A

Dilated anal and perianal collateral vessels that connect the portal and naval venous system to relieve elevated venous pressure with the hemorrhoid plexus.

32
Q

What risk factors hemorrhoids

A

Constipation and straining, pregnancy, portal hypertension, obesity and heavy lifts

33
Q

What steatorrhea and what are the signs

A 
it is frothy, foul smelling stool. 
signs : 
Bloating 
Cramps 
Diarrhea
Flatulence 
weigh loss
34
Q

What are the causes of Steatorrhea

A

CF
Celiac disease
Crohn disease

35
Q

What is Meconium ileus

A

the inability to pass the first feces meconium. is a sign of cystic fibrosis

36
Q

What is a differential diagnosis of meconium ileus

A

Hirschsprung disease

37
Q

What is Hirschsprung disease

A

it is the failure of neural crest cells to migrate and pass the meconium

38
Q

What is a good clue for Meconium ileus

A

CLUE: child comes in with a history of multiple respiratory infection - CF

39
Q

What is celiac disease

A

Celiac sprue or gluten sensitive enteropathy. immune mediate enteropathy triggered by the ingestion of gluten-containgn cereals ( wheat, rye or barley) in genetical predisposed people.

40
Q

What are the stats on Celiac disease

A

Caucasian
associated with outer autoimmune disease
HLD-DQ2 and 8
Females more than males

41
Q

What is the pathogenesis of Celiac disease

A

Gluten digested by luminal & brush order enzymes into amino acid Gliadin
Gliadin is De-aminated by tissue transglutaminase (tTG)
It then interacts with HLA-DQ2 or HLA-DQ8
Cytokines and anti-tissue transglutaminase, anti- gliadin & anti-endomysial antibodies produced
CD8+ cells produce IL-15 that triggers intra-epithelial lymphocytes
These lymphocytes become toxic and damage the epithelium

42
Q

What are the manifestation of celiac disease

A 
Bloating 
cramps
diarrhea 
gas 
weigh loss 
fatigue 
Bone - osteoporosis 
CNS - depression 
Skin - dermatitis Herpriormis
43
Q

What is a complication of celiac disease

A

Cancer - t-ccell lymphoma

44
Q

What is whipple disease

A

infection that is caused by trophermy Whippelli

45
Q

What is the pathogenesis of whipple disease

A

PAS-positive macrophages in lamina propria

Block lymphatics & reabsorption of chylomicrons

46
Q

What are the manifestation of Whipple disease

A 
Fever
Steatorrhea
Polyarthritis
Lymphadenopathy
Increase skin pigmentation
47
Q

What is lactose deficiency

A

Lactase are located in the apical brush border membrane of the villous absorptive epithelial cells

48
Q

What are the types lactose deficiency

A

Rare; Autosomal recessive

Acquired
Native Americans, African Americans, Chinese

Clues to diagnosis – symptoms resolve after stopping milk & milk products

Path 2 (22 decks)

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