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(DIT) Rapid Fire + 4/5 Stars > Small Intestines > Flashcards

Small Intestines Flashcards

1
Q

Duodenal atresia

A

failed to canalize

bilious vomiting, stomach distended

XR: double bubble - stomach w/ gass proximal to pyloris
-distention in blind duodenal pouch

Assoc w/ down syndrome

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2
Q

Conditions clogging biliary ducts

A

sludging of fluid - biliary sludge
gallstones
pancreatic tumor

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3
Q

ERCP

A

Endoscopic retrograde cholangiopancreatogram

Inject contract into ampulla of Vater to visual biliary tree

can cause pancreatitis w/ reversal of flow

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4
Q

Cholecystokinin (CCK)

A

I cells of duodenum

“pro duodenal”

  • decrease gastric emptying
  • increased pancreatic secretion
  • Gallbladder contraction
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5
Q

Secretin

A

S cells in duodenum

facilitates pancreatic HCO3- secretion neutralizes gastric acid

decreased gastric acid production - inhibit parietal cells

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6
Q

Gastric Inhibitory Peptide (GIP)

A

K cells
Decreased gastric acid production
increase insulin release - why PO glucose taken up by cells faster than IV glucose

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7
Q

Brunner glands

A

secrete alkaline mucus to neutralize gastric acid

hypertrophy w/ excess acid

only in duodenal submucosa

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8
Q

Somatostatin

A 
Inhibit secretion of:
gastrin
CCK
secretin
GIP
VIP
insulin
glucagon

D cells in GI and delta cells in pancreas

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9
Q

Vasoactive intestinal peptide (VIP)

A

Produced by sm.m. of GI and parasympathetic ganglia and enteric nervous system

relaxes sm.m. and sphincters throughout GI tract

increased secretion of electrolytes and water –> watery diarrhea

VIPoma of pancreas –> high volume rice water diarrhea like cholera

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10
Q

Motilin

A

produces migrating motor complexes

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11
Q

Ileus

A

no peristalsis

post op
stroke
septic shock

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12
Q

Prokinetic agents for ileus

A

Goal: increase ACh, Increase 5-HT (carcinoid syndrome), decrease D2

Cholinergic agonists - Bethanechol
Aceytlcholinesterase inhibitors - neostigmine

Metoclopramide (Reglan) - stimulates 5HT4, inhibits D2

  • used in gastroparesis of DM pts
  • SE: seizures, drug induced parkinsonism

Macrolides - stimulate sm.m. motilin receptors

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13
Q

Carbohydrate digestion and absorption

A

salivary amylase

pancreatic amylase –> disaccharides
Intestinal brush border enzymes –> monosaccharies

Glucose and galactose –> sodium dependent transporter

Fructose –> facilitated diffusion

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14
Q

Protein digestion and absorption

A

Pancreatic proteases –>

aa –> sodium dependent transport

di-, tri-peptides –> H+ gradient = faster

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15
Q

Trypsinogen

A

autoactivation or enterokinase in brushborder –> trypsin

cleaves arginine and lysine

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16
Q

Lipid digestion and absorption

A

salivary lipase and stomach –> triacylglycerol

pancreatic lipase –> FA, 2-monoacylglycerol

Bile salts emulsify hydrolized products –> micelles –> triglycerides, cholesterol –> chylomicrons –> liver

17
Q

pancreatic lipase deficiency

A

chronic pancreatic inflammation –> decreased lipase = decreased lipid digestion

18
Q

Iron absorption and deficiency

A

duodenum

cause: antacids and certain abx; gastric bypass sx

19
Q

Folate absorption and deficiency

A

duodenum
jejunum

Def: poor nutrition (e.g. alcoholism)
Infants exclusively fed goats milk

20
Q

B12 absorption and deficiency

A

terminal ileum - requires intrinsic factor

Def: malnutrition, pernicious anemia

21
Q

Abetalipoproteinemia

A

AR
Lack apoB –> defective chylomicron assembly

apoB48 tells chylomicron to leave enterocytes - without it it accumulates

Acanthocytes - star shaped RBCs

Presents early childhood:
steatorrhea
malabsorption - ADEK deficient
failure to thrive
ataxia
22
Q

Lactase deficiency

A

lactase in tips of microvilli
-gastroenteritis can blunt microvilli –> temporary lactose intolerance

sx: bloating, cramping, diarrhea

supplement enzyme or avoid lactose

23
Q

Tropical sprue

A

likely infectious cause
can affect entire small bowel

vitamin deficiency
Megaloblastic anemia

not better w/ removal of gluten

better with abx

24
Q

Whipple disease

A

Tropheryma whipplei

wt loss
LAD
hyperpigmentation
cardiac sx
arthralgias
neurological sx

PAS+ foamy macrophages laden w/ t. whipplei in intestinal lamina propria

Older white males

Tx: PCN, ampicillin, tetracycline x 1-2 YEARS!
less than 1 yr tx has 40% relapse rate

25
Q

Bacteria overgrowth of small intestine

A

N/V/D
bloating
malabsorption

signs of inflammation on histo

dx: aspirate from jejunum - grow out –> excess growth

risk:
dysmotility
fistulas
diverticula
ileocecal valve resection
gastroenteritis
Meds: PPIs

Tx:
Abx/probiotics - contraversial
Intermittent as relapse common

26
Q

Pancreatic insufficiency

A

d/t chronic pancreatitis, CF, obstruction of duct (gallstones, cancer)

fat malabsorption - ADEK def
steatorrhea

27
Q

Meckel’s diverticulum

A

MC congenital anomaly in GI
Incomplete obliteration of omphalomesenteric duct (vitilline duct)

five 2's
-2 inches long
2 feet from ileocecal valve
2% of population
first 2 years of life
2 types of tissue- pancreatic and gastric
It causes:
Melena
RLQ pain
intussusception
volvulus
obstruction
28
Q

Intussusception

A

telescoping of sm. bowel into itself
MC abdominal emergency under 2 yo
Near ileocecal junction
unusual for adults

75% idiopathic
Viruses - esp adenovirus

Currant jelly stools
sudden severe abdominal pain, V

US: “bull’s eye” or “coiled spring”

29
Q

Intestinal ileus

A

Lack peristalsis in GI tract
post op or severe illness

d/t decreased blood flow to gut - diverted to areas of healing

30
Q

Meconium ileus

A

meconium not passed in first days after birth

causes: CF, hirschsprung dz

31
Q

Necrotizing enterocolitis

A

Premature - bowel necrosis, orally fed

sx: feeding intolerance, increaed gastric residuals, abdominal distention, bloody stools
- -> perforation

XR: dilated loops of bowel
paucity of gas
pneumatosis intestinalis - gas in wall of small or large intestine

Tx: bowel rest, parenteral nutrition

32
Q

Intestinal ischemia

A

Mesenteric ischemia - small intestine
-has chronic form d/t atherosclerosis; typically pain after eating in older male

Ischemic colitis - large intestine

Causes:
Inadequate blood supply
-watershed of splenic flexure at risk

Splanchnic vasoconstriction
Acute arterial occlusion
Venous thrombosis
hypoperfusion of mesenteric vasculature

Typically elderly patient w/ abdominal pain out of proportion to exam findings

Labs: nonspecific
Plain XR: dilated loops of bowel and bowel wall thickening
CT angio diagnostic

Tx underlying cause:
Venous thrombosis - anticoagulation
Arterial embolism - early surgical laparotomy w/ embolectomy
nonocclusive d/t vasoconstriction - remove vasoconstrictive drugs
bowel necrosis - resect

33
Q

Angiodysplasia

A

small vascular malformation in GI
Tend to bleed - unxplained GI bleeding and anemia

Cecum or ascending colon

Dx: colonscopy, angiography

older patients

34
Q

Irritable bowel syndrome (IBS)

A

chronic abdominal pain and altered bowel habits
abd pain: crampy w/ variable intensity - improves with defecation

Diarrhea, constipation or alternating

Other sx: GERD, dysphagia, early satiety, nausea, and chest pain

Non GI: urinary frequency and urgency, dysmenorrhea, dyspareunia, fibromyalgia

tx: diet modificaiton (lactose or gluten), fiber supplement, antispasmodics (dicyclomine and hyoscyamine) antidepressants (TCA, SSRI), guanylate cyclase agonists (IBS w/ constipation)

NOT associated: rectal bleeding nocturnal abdominal pain, wt loss, anemia, elevated inflammatory markers, electrolyte abnormalities

35
Q

Common causes of SBO?

A

XR: dilated loops of bowel

ABCs
Adhesions - surgical 75%
Bulge - hernia
Cancer - tumors - mets colorectal cancer

Other less common:
volvulus, intussusceptions, Crohn’s dz, gallstone ileus, bezoar, bowel wall hematoma from trauma, inflammatory stricture, congenital malformation, radiaiton enteritis

36
Q

Carcinoid tumor

A

neuroendocrine –> hormone secretion
-Histamine, prostaglandin
Most importantly serotonin

50% of small intestinal tumors
Appendix, ileum, rectum, lung
sx d/t excess serotonin –> carcinoid syndrome

If in intestine only liver metabolizes serotonin via first pass, no sx.
Mets outside of GI or primary lung cause sx

37
Q

Carcinoid syndrome

A 
BFDR
Bronchospasm
Flushing
Diarrhea
Right sided valvular heart disease (edema, ascities)

(DIT) Rapid Fire + 4/5 Stars (162 decks)

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