Small Intestine and colon Part 1 Flashcards
What causes the obstruction os the small intestine
80% are Lesions hernias, intestinal adhesion, intussusception and volvulus
10 to 15% are tumors, infraction and other causes of strictures, Crohn Disease
What are the manifestations of Intestinal Obstruction
Abdominal Pain and discomfort and vomiting and constipations
What is the mechanism of Intestinal Obstruction
Normal flow of intestinal contents is disrupted - proximal dilation + distal decompression
What are the complication of Intestinal obstructions
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
What is the presentation of Small bowel Obstruction
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
What is the presentation in Large Bowel Obstruction
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
What is the prestantion of Pseudo-Obstruction
Nausea and vomiting occurs Abdominal pain is minimal distension occurs constipation occurs Bowel sounds decrease in X-ray the is an increase in air
What are the causes of small bowel obstruction
S - stricture H - hernia - 2nd cause A- adhesion - MCC V -volvulus I - intussception N - Neoplasm 3rd cause G - Gallstones
What are the causes of large bowel obstruction
Cancer
Diverticulitis
Volvulus
What is adhesions
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.
What is a hernia
Defect in fascia - protrusion of bowel into sac. Males are more likely than females. Most common is the indirect (50%).
What is the Progression of the Hernia?
Entrapment, Incarceration, Strangulation ( Blood supply to the part of the bowel is blocked) and Infarction
What are the risk factors of hernia
Chronic Cough Pregnancy Constipation Obesity Ascites Straining Hernia repair Heavy lifting
What are the features of Hernia
Bulging with the patients coughs, sits ups and goes away when the patient is upon or when reduces
REMEMBER MD’s don’t lie
What is Volvulus? What is the most common area
Rotation of a segment of bowel about its mesenteric axis.
Sigmoid Colon due to the shape
What is intussusception
Part of bowel folds into another section of bowel ( telescoping) Mostly seen in the Kids: M>F
What are the complications of Intussusception
Obstruction, infarction and necrosis
What are the clues of intussusception
Sausage shaped Palpable mass
Rectal Bleeding
Kids Crises and draws knees up to chest
DONUT!!!!! or Target sign!!!
What is a major of Intussusception
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.
What is colonic Pseudo-Obstruction and what are the types
Symptoms similar to intestinal blockage but no physical signs of blockage.
Paralytic ileus and Ogilvie’s syndrome
What is paralytic ileus?
Temporary paralysis of myeneteic plexus. tends to occur in postoperative surgeries and medications
What is ogilivie syndrome
Acute pseudo obstruction. tends to happen in bedridden patients that have a serious extra intestinal illness like trauma, infection and cardiac
What is ischemic bowel disease
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
What are the causes of ischemic bowel disease
Clots Atrial Fibrillations DVT Cardiac Vegetation Malignancy
Low Perfusion/ Hemorrhage CHF Shock Dehydration Vasoconstriction drugs
What are the signs of Ischemic Bowel Disease
Sudden severe left sided abdominal pain and bloody stools
What is Necrotizing Enterocolitis
blood vessels have not completely developed. leads to bowel necrosis. That happens in premature infants
What is the sign and symptoms Necrotizing Enterocolitis
Poor feeding
Abdominal distension
Bloody stools
What is angiodysplasia
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.
What is the MCC of Angiodysplasia
DIVERTICULOSIS
What is the associated angiodysplasia
aortic stenosis. vWF gets damaged due to high stress at the aortic valve and it leads to bleeding
What are hemorrhoids
Dilated anal and perianal collateral vessels that connect the portal and naval venous system to relieve elevated venous pressure with the hemorrhoid plexus.
What risk factors hemorrhoids
Constipation and straining, pregnancy, portal hypertension, obesity and heavy lifts
What steatorrhea and what are the signs
it is frothy, foul smelling stool. signs : Bloating Cramps Diarrhea Flatulence weigh loss
What are the causes of Steatorrhea
CF
Celiac disease
Crohn disease
What is Meconium ileus
the inability to pass the first feces meconium. is a sign of cystic fibrosis
What is a differential diagnosis of meconium ileus
Hirschsprung disease
What is Hirschsprung disease
it is the failure of neural crest cells to migrate and pass the meconium
What is a good clue for Meconium ileus
CLUE: child comes in with a history of multiple respiratory infection - CF
What is celiac disease
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.
What are the stats on Celiac disease
Caucasian
associated with outer autoimmune disease
HLD-DQ2 and 8
Females more than males
What is the pathogenesis of Celiac disease
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
What are the manifestation of celiac disease
Bloating cramps diarrhea gas weigh loss fatigue Bone - osteoporosis CNS - depression Skin - dermatitis Herpriormis
What is a complication of celiac disease
Cancer - t-ccell lymphoma
What is whipple disease
infection that is caused by trophermy Whippelli
What is the pathogenesis of whipple disease
PAS-positive macrophages in lamina propria
Block lymphatics & reabsorption of chylomicrons
What are the manifestation of Whipple disease
Fever Steatorrhea Polyarthritis Lymphadenopathy Increase skin pigmentation
What is lactose deficiency
Lactase are located in the apical brush border membrane of the villous absorptive epithelial cells
What are the types lactose deficiency
Rare; Autosomal recessive
Acquired
Native Americans, African Americans, Chinese
Clues to diagnosis – symptoms resolve after stopping milk & milk products
