Small Intestine Disorders

Question 1

appendicitis eti & s/s

Answer 1

• fecalith
• dull periumbilical (prog to sharp RLQ), anorexia, N/V, low F
• McBurney’s point (RLQ), Obturator sign (hip & knee flex 90), Psoas sign (on side, pull leg back, retrocaecal), Rovsing’s sign (LLQ)

Question 2

appendicitis WU & mgmt

Answer 2

• CBC (late finding), abd CT pref (unless preg/ped = US)
• surg, cipro/zosyn if abscess/rupture (then appy in 3-4 wks)
• if abscess, could be colon CA

Question 3

Celiac dz eti

Answer 3

• immune-mediated inflammation of small intestine from gluten sens
• white/European
• genetic

Question 4

celiac screening

Answer 4

• pts w/ FTT, chronic D/C, recurrent abd pain, dental enamel hypoplasia, idiopathic short stature, pubertal delay, refractory iron def anemia
• 1st deg rels of pts w/ celiac, autoimmune thyroiditis/hepatitis, T1DM, Down’s, Turner’s, Williams, IgA def

Question 5

celiac s/s

Answer 5

• malabsorption (D, steatorrhea, wt loss, vit defs)
• most have minor sx/asx
• 2ndary hyperparathyroidism from vit D def

Question 6

comorbid autoimmune dz of celiac

Answer 6

dermatitis herpetiformis (chronic, itchy, bumps/blisters), T1DM, thyroiditis

Question 7

celiac wu

Answer 7

• def dx = endoscopy w/ small bowel bx (villous atrophy)
• IgA can be false neg as many are deficient
• screen for skind dz, T1DM, thyroiditis, bone density
• pos serology w/ neg bx = ? latent dz

Question 8

celiac mgmt

Answer 8

• gluten-free
• rpt bx if dx uncertain
• pneumovax (b/c assoc w/ hyposplenism)
• latent = monitor, tx if sx develop

Question 9

Intussusception eti/epi

Answer 9

• MC cz of intestinal obstruction in < 1 y.o.
• most 6 mos - 3 y.o.
• can occur multiple times
• idopathic (MC), viral, Meckel diverticulum (incomplete obliteration of the vitelline duct: outpouching)

Question 10

intussusception s/s

Answer 10

• periodic, colicky abd pain, V, “currant jelly” stools, palpable mass/”sausage” in RUQ, lethargy

Question 11

intussusception ddx, wu, mgmt

Answer 11

• malignancy if > 3 y.o.
• XR (SBO), US = TEST OF CHOICE (“pseudokidney sign”, “lasagna sign”)
• ref for emergent reduction via enema or surg repair

Question 12

small bowel neoplasms eti, s/s, RF

Answer 12

• rare compared to lg bowel CA
• MC in ileum (carcinoid tumor)
• s/s: crampy, intermittent abd pain, wt loss, N/V, GIB, obstruction (usually asx if b9)
• RF: familial CA synd (FAP, HNPCC, Peutz-Jeghers)

Question 13

B9 small bowel neoplasms

Answer 13

• adenoma: villous (can become mal) and tubular adenoma (inc risk of colon CA, MC in duodenum)
• leiomyoma: submucosa
• lipoma: submucosal/subserosal adipose
• others: desmoid tumor (connective tissue), hemangioma, fibroma

Question 14

malignant small bowel neoplasms

Answer 14

• adenocarcinoma: glandular, duodenum
• carcinoid tumor: MC, ileum, neuroendocrin, carcinoid synd w/ mets (watery D, flushing, sweating, wheezing, dyspnea, abd pain, hypotension)
• lymphoma: MC non-Hodgskin (poorer prog), includes MALT (mucosa-associated lymphoid tissue ), large B-cell, mantle cell, and Burkitt lymphoma
• sarcoma: MC = GIST, can become MAL, resect if > 2 cm, mets = rare