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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
Q

Fat Malabsorption Vit

A

lll

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26
Q

Celiac Sprue

A

gluten sensitive enteropathy (wheat, barley, rye)

- inflammatory dz of SI –> loss of villi, crypt hyperplasia, IE Lymphocytes

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27
Q

Prevalence of celiac sprue

A
  1. 5-1% of US population–80% asymptomatic

- incidence increases with age

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28
Q

Typical signs/symptoms of celiac sprue

A

abd pain/distention, anorexia, steatorrhea, diarrhea, flatulence, failure to thrive, vomiting

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29
Q

Atypical Celiac Sprue signs/symptoms

A

Fe deficiency anemia, Dermatitis herpetiformis, Liver function tests (AST, ALT elevations), cerebellar ataxia, osteoporosis, oral apthous ulcers

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30
Q

Celiac pathogenesis

A
  • 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
Q

Alleles associated with Celiac

A

HLA-DQ2, HLA-DQ8 (40% ofUS)

  • 2-5% gene carriers develop dz
32
Q

Celiac diabnosis

A
  • findings on biopsy

- Serology tests: anti-tissue transglutaminases (BEST), anti endomysial antibodies, anti=gliadin IgA and IgG

33
Q

Celiac treatment

A

Gluten free diet

  • corn, rice, soy, millet
  • expensive but prices have gone down
34
Q

Tropical Sprue population/cause

A
  • tropics residents/visitors (around 30 days)

- Cause: bacterial toxins or colonization of aerobic coliform bacteria

35
Q

Classic presentation of tropical sprue

A

Megaloblastic anemia from B12 and folate deficiency

36
Q

Diagnosis of tropical sprue

A

intestinal biopsy with villous flattening/travel hx

37
Q

Treatment of tropical sprue

A

Antibiotics, B12, folate

38
Q

Whipple’s dz cause

A

RARE!!

- Gram + actinomycete: T whippelii

39
Q

signs of Whipple’s d

A

fever, joint, pain, diarrhea, abd pain, CNS-neurologic symptoms

40
Q

Diagnosis of Whipple’s dz

A

PAS+ Macrophages on biopsy, PCR

41
Q

Treatment of Whipple’s dz

A

1 yr antibiotics

42
Q

Mesenteric Ischemia

A
  • atherosclerosis, clot, radiation
43
Q

Causes/sxs of acute mesenteric ischemia

A
  • Acute: embolus –> severe abd pain

- usually some necrotic bowel and need surgery

44
Q

Causes/symptoms of chronic mesenteric ischemia

A
  • Chronic: 2 of 3 major vessels occluded

- Sxs- post-prandial abd pain, weight loss, sitophobia, malabsorption

45
Q

Malabsorption diagnostic tests

A
  • focused testing- clinic scenario

- fecal fat, vitamin levels, CBC, albumin, CT-SI/liver/pancreas/bile ducts, endoscopy

46
Q

SI tumor prevalence

A

very rare cause of primary tumors (

47
Q

Type of SI tumors/prevalence

A

Adenocarcinoma (47%–most duodenum)> Carcinoid (28%)> sarcoma (13%)> Lymphoma (12%)
- metastasis

48
Q

presentation of SI tumor

A

sxs of obstruction (abd pain/distention, decreased tool output)

49
Q

2 main causes of diarrhea

A

Decrased absorption of fluid/electrolytes, increased secretion of fluid/electrolytes

50
Q

Diarrhea main concept

A

colonic water load > absorptive capacity

51
Q

Causes of decreased fluid/electrolyte absorption

A
  • inhibited/defective absorption of fluid and/or electrolytes
  • luminal osmotic agents
  • increased motility with decreased contact time
52
Q

Causes of increased fluid/electrolyte secretion

A

stimulated anion secretion, increased crypt secretion

53
Q

4 classes of stool

A

Fatty, watery, inflammatory/exudative, functional

54
Q

Fatty diarrhea

A

malabsorption/maldigestion

55
Q

watery diarrhea causes

A

osmotic/secretory

56
Q

Causes of Osmotic watery diarrhea

A
  • *poorly absorpbed luminal osmols
  • Carbohydrate malabsorption (lactose, sorbitol, fructose)
  • Osmotic laxatives (Mg containing, phosphagte, sulfate (colonoscopy bowel preps)
57
Q

Osmotic vs secretory diarrhea

A
  • measure stool Na/K
  • nl osmolarity = 290 mOsm
  • Osm gap = 290-2 (stool Na + K)
  • if difference >50 mOsm, diarrhea is osmotic
  • difference
58
Q

Lactose Intolerance

A

> 50% world down-regulates lactase after weaning

- lactose indigestion –> osmotic diarrhea , flatulence (colonic bacteria)

59
Q

lactose intolerance cause

A

mutations in lactase promoter –> lactase persistence in 80% Northern European and nomadic popoulations

60
Q

Secretory Watery Diarrhea causes

A
  • Bacterial toxins
  • Neuroendocrine tumors
  • Ileal bile salt malabsorption
  • stimulant laxatives
  • Disordered motility/regulation (diabetic neuropathy, postvagotomy, IBS)
61
Q

Fatty Diarrhea causes

A
  • malabsorption syndormes

- maldigestion /malabsorption

62
Q

malabsorption syndromes

A
  • mucosal dzs (Celiac dz, Whipple’s)
  • short bowel syndrome
  • small bowel bacterial overgrowth
63
Q

maldigestion/malabsorption syndromes

A
  • pancreatic insufficiency

- inadequate luminal bile salt concentration (chronic lever dz, biliary obstruction)

64
Q

Inflammatory diarrhea causes

A

Infection, IBD( Crohn’s, UC), ischemia

65
Q

mechanisms of inflammaory diarrhea

A

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
Q

Fecal leukocytes in intestinal infections

A
  • Present - Shigella, Campylobacter, Enterohemorrhagic/enteroinvasis E. coli
  • Variable (Salmonella, Yersinia, C diff–pseudomembranous colitis)
  • Absent (V. cholerae, Enterotoxigenic E coli, Giardia lamblia)
67
Q

Inflammatory Diarrhea Diagnosis

A
  • Infection – stool culture, Endoscopy
  • Ischemia (CT scan, Endoscopy-colon)
  • IBD - endoscopy
68
Q

Irritable Bowel Syndrome (IBS)

A

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
Q

IBS prevalence

A

10-15% population

70
Q

IBS possible mechanisms

A

visceral hypersensitivity, carbohydrate malabsorption, low-grade inflammation

71
Q

When to be concerned with IBS (maybe other problem)

A

weight loss, rectal bleeding, anemia, nocturnal symptoms, electrolyte abnormalities, elevated inflammatory markers

72
Q

Bacterial toxins asociated with secretory watery diarrhea

A

V cholerae, E. coli enterotixins

73
Q

Neuroendocrine tumors associated with secretory watery diarrhea

A

gastrinoma, VIPoma, carcinoids, calcitonin

DEMS unit 1 (15 decks)

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