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DEMS unit 1 > Small Intestine Disorders > Flashcards

Small Intestine Disorders Flashcards

1
Q

Appendix function

A

perhaps vestigal remnant, storage for good bacteria, maybe immune regulator

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2
Q

Diseases of Appendix

A

appendicitis most common, tumors rare

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3
Q

Appendix tumors

A

Rare

  • Carcinoid (0.5% of appendectomy specimens) (neuroendocrine)
  • metastasis rare if tumor
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4
Q

absorption/transport of fluids

A

9L secreted/ingested, 8.9 L absorbed (SI–8.4 L and colon about 400 mL), 100 ml secreted

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5
Q

Malabsorption/maldigestion

A

syndrome of disordered/inadequate nutrient absorption

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6
Q

Malabsorption clinical signs

A

weight loss, diarrhea, steatorrhea, vitamin deficiencies

  • pale, bulky, malodorous stool (float/difficult to flush, oily residue)
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7
Q

Causes of malabsorption

A

Surgery, bacterial overgrowth, meds, pancreatic insufficiency, liver dz, intestinal inflammation/villus flattening, ulceration, ischemia, infiltration

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8
Q

surgical causes of malabsorption

A

gastric bypass, small bowel resection

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9
Q

medications causing malabsorption

A

cholestyramine - ADEK, phenytoin-folate

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10
Q

intestinal inflammation/villus flattening causes

A

celiac sprue, Whipple’s disease, tropical sprue

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11
Q

Infiltration causing malabsorption example

A

amyloidosis

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12
Q

Pancreatic insufficiency

A

90% of pancreas burned out
- Digestive enzymes (lipase, trypsin, etc)

lipid maldigestion first, protein malabsorption, carb malabsorption rare

chronic pancreatitis
cystic fibrosis

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13
Q

Liver dz

A

Cirrhosis
- decreased fxn of hepatocytes, decreased bile formation (need for lipid absorption)

Biliary obstruction

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14
Q

Gastric bypassp roblems

A

inadequate mixing of food with biliary and pancreatic secretions

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15
Q

gastric bypass vitamin deficiencies

A
  • B12, Fe, Ca, Vit D most common
  • Vit C, Cu rare
  • Prevent: multivitamin
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16
Q

bacteria in ailimentary tract

A

400-500 species

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17
Q

Small Bowel bacterial overgrowth

A
  • Normal bacteria
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18
Q

clinical signs of bacterial overgrowth in SI

A

diarrhea, steatorrhea, abd pain, bloating, weight loss

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19
Q

Hypomobility problems causing bacterial overgrowth

A

diabetes, scleroderma, narcotics

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20
Q

anatomic abnormalities causing SI bacterial overgrowth

A

diverticular, blind loop (BII), IC valve resection

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21
Q

Bacterial overgrowth vitamin deficiencies

A

fat soluble vitamin/B12 deficiency

  • bacteria de-conjugate bile salts and consume B12
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22
Q

Bacterial overgrowth folate levels

A

normal to high–>bacterial production

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23
Q

Bacterial overgrowth diagnosis

A

aspiration of duodenum with culture, glucose-hydrogen breath test, empiric treatment with antibiotics

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24
Q

Treat bacterial overgrowth

A

antibiotics (Ciprofloxacin, i.e.)

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25
Fat Malabsorption Vit
lll
26
Celiac Sprue
gluten sensitive enteropathy (wheat, barley, rye) | - inflammatory dz of SI --> loss of villi, crypt hyperplasia, IE Lymphocytes
27
Prevalence of celiac sprue
0. 5-1% of US population--80% asymptomatic | - incidence increases with age
28
Typical signs/symptoms of celiac sprue
abd pain/distention, anorexia, steatorrhea, diarrhea, flatulence, failure to thrive, vomiting
29
Atypical Celiac Sprue signs/symptoms
Fe deficiency anemia, Dermatitis herpetiformis, Liver function tests (AST, ALT elevations), cerebellar ataxia, osteoporosis, oral apthous ulcers
30
Celiac pathogenesis
- associated with autoimmune dz (Female: male 2:1) - APC-MHC II present gluten peptides - CD4 T cell response - all have Ab to tissue transglutaminase
31
Alleles associated with Celiac
HLA-DQ2, HLA-DQ8 (40% ofUS) - 2-5% gene carriers develop dz
32
Celiac diabnosis
- findings on biopsy | - Serology tests: anti-tissue transglutaminases (BEST), anti endomysial antibodies, anti=gliadin IgA and IgG
33
Celiac treatment
Gluten free diet - corn, rice, soy, millet - expensive but prices have gone down
34
Tropical Sprue population/cause
- tropics residents/visitors (around 30 days) | - Cause: bacterial toxins or colonization of aerobic coliform bacteria
35
Classic presentation of tropical sprue
Megaloblastic anemia from B12 and folate deficiency
36
Diagnosis of tropical sprue
intestinal biopsy with villous flattening/travel hx
37
Treatment of tropical sprue
Antibiotics, B12, folate
38
Whipple's dz cause
RARE!! | - Gram + actinomycete: T whippelii
39
signs of Whipple's d
fever, joint, pain, diarrhea, abd pain, CNS-neurologic symptoms
40
Diagnosis of Whipple's dz
PAS+ Macrophages on biopsy, PCR
41
Treatment of Whipple's dz
1 yr antibiotics
42
Mesenteric Ischemia
- atherosclerosis, clot, radiation
43
Causes/sxs of acute mesenteric ischemia
- Acute: embolus --> severe abd pain | - usually some necrotic bowel and need surgery
44
Causes/symptoms of chronic mesenteric ischemia
- Chronic: 2 of 3 major vessels occluded | - Sxs- post-prandial abd pain, weight loss, sitophobia, malabsorption
45
Malabsorption diagnostic tests
- focused testing- clinic scenario | - fecal fat, vitamin levels, CBC, albumin, CT-SI/liver/pancreas/bile ducts, endoscopy
46
SI tumor prevalence
very rare cause of primary tumors (
47
Type of SI tumors/prevalence
Adenocarcinoma (47%--most duodenum)> Carcinoid (28%)> sarcoma (13%)> Lymphoma (12%) - metastasis
48
presentation of SI tumor
sxs of obstruction (abd pain/distention, decreased tool output)
49
2 main causes of diarrhea
Decrased absorption of fluid/electrolytes, increased secretion of fluid/electrolytes
50
Diarrhea main concept
colonic water load > absorptive capacity
51
Causes of decreased fluid/electrolyte absorption
- inhibited/defective absorption of fluid and/or electrolytes - luminal osmotic agents - increased motility with decreased contact time
52
Causes of increased fluid/electrolyte secretion
stimulated anion secretion, increased crypt secretion
53
4 classes of stool
Fatty, watery, inflammatory/exudative, functional
54
Fatty diarrhea
malabsorption/maldigestion
55
watery diarrhea causes
osmotic/secretory
56
Causes of Osmotic watery diarrhea
* *poorly absorpbed luminal osmols - Carbohydrate malabsorption (lactose, sorbitol, fructose) - Osmotic laxatives (Mg containing, phosphagte, sulfate (colonoscopy bowel preps)
57
Osmotic vs secretory diarrhea
- measure stool Na/K - nl osmolarity = 290 mOsm - Osm gap = 290-2 (stool Na + K) - if difference >50 mOsm, diarrhea is osmotic - difference
58
Lactose Intolerance
>50% world down-regulates lactase after weaning | - lactose indigestion --> osmotic diarrhea , flatulence (colonic bacteria)
59
lactose intolerance cause
mutations in lactase promoter --> lactase persistence in 80% Northern European and nomadic popoulations
60
Secretory Watery Diarrhea causes
- Bacterial toxins - Neuroendocrine tumors - Ileal bile salt malabsorption - stimulant laxatives - Disordered motility/regulation (diabetic neuropathy, postvagotomy, IBS)
61
Fatty Diarrhea causes
- malabsorption syndormes | - maldigestion /malabsorption
62
malabsorption syndromes
- mucosal dzs (Celiac dz, Whipple's) - short bowel syndrome - small bowel bacterial overgrowth
63
maldigestion/malabsorption syndromes
- pancreatic insufficiency | - inadequate luminal bile salt concentration (chronic lever dz, biliary obstruction)
64
Inflammatory diarrhea causes
Infection, IBD( Crohn's, UC), ischemia
65
mechanisms of inflammaory diarrhea
1) stimulated secretion and inhibited absorption 2) stimulation of enteric nerves causing propulsive contractions and stimulated secretion 3) mucosal destruction and increased permeability 4) nutrient maldigestion/malabsorption
66
Fecal leukocytes in intestinal infections
- Present - Shigella, Campylobacter, Enterohemorrhagic/enteroinvasis E. coli - Variable (Salmonella, Yersinia, C diff--pseudomembranous colitis) - Absent (V. cholerae, Enterotoxigenic E coli, Giardia lamblia)
67
Inflammatory Diarrhea Diagnosis
- Infection -- stool culture, Endoscopy - Ischemia (CT scan, Endoscopy-colon) - IBD - endoscopy
68
Irritable Bowel Syndrome (IBS)
Abd pain and altered bowel habits in absence of organic cause - pain improved with defecation - pain onset with change in stool frequency or appearance - constipation and/or diarrhea
69
IBS prevalence
10-15% population
70
IBS possible mechanisms
visceral hypersensitivity, carbohydrate malabsorption, low-grade inflammation
71
When to be concerned with IBS (maybe other problem)
weight loss, rectal bleeding, anemia, nocturnal symptoms, electrolyte abnormalities, elevated inflammatory markers
72
Bacterial toxins asociated with secretory watery diarrhea
V cholerae, E. coli enterotixins
73
Neuroendocrine tumors associated with secretory watery diarrhea
gastrinoma, VIPoma, carcinoids, calcitonin

DEMS unit 1 (15 decks)

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