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MHD > Small/Large Intestine > Flashcards

Small/Large Intestine Flashcards

1
Q

Specific Feature of Duodenum

A

Brunner’s Glands

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2
Q

Specific Feature of Ileum

A

Peyer’s Patch

M cells

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3
Q

Intussusception

A

telescoping of bowel segment into distal segment
compromised blood supply= abdominal pain with currant jelly stools

Children-idiopathic or infection related
Adult-mass or tumor

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4
Q

volvulus

A

twisting of bowel around its mesentery
-leads to obstruction and infarction
children-midgut
adults-sigmoid

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5
Q

Necrotizing Enterocolitis

A

acute, necrotizing inflammation of small and or large intestine

  • multifactorial
  • terminal ileum or ascending colon
  • edema to necrosis to gangrenous bowel
  • most common acquired GI emergency in PREMATURE or low birth weight neonate
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6
Q

Meckel’s Diverticulum

A

Persistence of omphalomesenteric duct (vitelline duct)

2% of pop
2:1 M
2’’ length
2 ft of ileocecal valve
2 types of ectopic tissue in 1/2 of cases (gastric and pancreatic)
2 major complications (pain with inflammation; hemorrhage with ulcer)

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7
Q

Hirschsprung Disease

A 
Congenital Aganglionic Megacolon
Absence of ganglion cells
M:F 4:1
Premature arrest or death of the neural crest cell migration from the cecum to the rectum
1 in 5000 live births 
-Down syndrome (10%)
5% serious neurologic abnormalities
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8
Q

What are signs of malabsorption? What can it lead to?

A

Chronic Diarrhea, steatorrhea, weight loss, abdominal pain, flatus

Pyridoxine, folate, VB12, Anemia
Vit K: bleeding
Ca, Mg, and Vit D: osteopenia and tetany
Vit A and Vit D: peripheral neuropathy

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9
Q

What things can cause pancreatic insufficiency? What does this lead to?

A

Chronic pancreatitis
Cystic Fibrosis
Obstructing cancer

Leads:
Malabsorption of fat and fat soluble vitamins (ADEK)

  • increased neutral fat
  • normal D-xylose absorption test
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10
Q

Disaccharidase Deficiency

A

Most common-lactase deficiency
Osmotic diarrhea
Can occur if injury to tips of intestinal villi (where lactase is located)

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11
Q

Abetalipoproteinemia

A

Decreased synthesis of apolipoprotein B- decreased ability to generate chylomicrons-decreased secretion of cholesterol-fat accumulates in enterocytes
-presents early childhood with failure to thrive

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12
Q

Celiac Disease

A

Digestive and autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten

  • whites
  • .5-1% prevalence

Infants: diarrhea, failure to thrive, abdominal distention, anorexia, weight loss, irritability
Older children: abdominal pain, nausea, vomiting, bloating or constipation
Adults: diarrhea, flatulence, weight loss, and fatigue and anemia
-Dermatitis herpetiformis

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13
Q

How do you make the diagnosis of Celiac disease?

A

Serologic studies:
IgA or IgG antibodies to tissue transglutaminase (TTG)
IgA or IgG antibodies to deaminated gliadin
IgA endomysial antibodies
(sepcific but less sensitive)

(may have IgA def)

Absence of HLA-DQ2 or HLA-DQ8 has high negative predictive value

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14
Q

What does celiac look like on histology and endoscopy?

A

Endoscopy:

  • atrophic mucosa
  • flattened folds

Histology:
Loss of villi
Increased numbers of intraepithelial CD8+ T cell lymphocytes

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15
Q

Tropical Sprue

A

Similar findings to celiac sprue but responds to antibiotics
Cause unknown
seen in residents/recent visitors to tropics

Damage: jejunum (folic acid) and ilium( B12)

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16
Q

In infectious enterocolitis=acute colitis where are the neutrophils?

A

neutrophils in the epithelium and lamina propria

17
Q

Nematode-Ascaris

A

largest intestinal roundworm and is the most common helminth infection of human worldwide

  • eggs are deposited in feces and soil
  • infestation can cause morbidity by compromising nutritional status, affecting cognitive process, inducing tissue reactions such as granuloma to larval stages, and by causing intestinal obstruction, which can be fatal
18
Q

Flatworms

A

Tapeworm: taenia and diphyllobothrium

-ingestion of raw or undercooked fish, meat or pork that contains the encysted larvae

19
Q

Giardia

A

Most common parasite infection in humans

-spread by fecally contaminated food and water

20
Q

Entamoeba Histolytica

A

cyts survive outside the host in water, in soil and on foods

  • release the trophozoite stage in the digestive tract
  • can be asymptomatic or lead to amoebic dysentery or amoebic liver abscess
  • fulminating dysentery, bloody diarrhea, weight loss, fatigue, abdominal pain
  • flask shaped ulcer
21
Q

Pseudomembrane colitis

A
  • most often after antibiotics
  • yellow green false membrane (mixture of mucous and neutrophils)
  • toxin produced by clostridium difficile
  • intractable diarrhea, cramps, dehydration, shock, death

Histology
-mushroom shaped

22
Q

Collagenous colitis

A

Clinical:

  • chronic watery diarrhea
  • 3-20 non-bloody stools per day
  • middle age and older women
  • radiographic studies unremarkable
  • normal endoscopic findings

Histology:
subepithelial collagen

23
Q

Lymphocytic colitis

A

Clinical:

  • chronic watery diarrhea
  • 3-20 non-bloody stools per day
  • affects males and females equally
  • radiographic studies unremarkable
  • endoscopic findings normal
  • strong association with autoimmune disease

Histology:
intraepithelial lymphocytes
NO epidermal collagen-Trichrome negative!

24
Q

Whipple Disease

A

Rare
Gram positive rod shaped actinomycete: tropheryma whipplei
-engulfed by macrophages(PAS positive diastase resistant)
More common in men
Malabsorption, lymphadenopathy, and arthritis

Histology:
Lamina propria distended with foamy macrophages
PAS positive organisms

25
Q

Inflammatory Bowel Disease

A

Increasing in incidence-hygiene hypothesis
Genetics-increased risk in family
Mucosal immune response-immune suppression is treatment
Epithelial defects-defects in tight junctions maybe paneth cell issues
Microbiota-change in the bacterial flora especially in the mucous

26
Q

Crohn’s Disease Clinical

A

Teen/twenties and fifties/sixties
Caucasians> non Caucasian
Jewish>non Jewish
Disordered response to bacteria

Diarrhea, crampy abdominal pain: RLQ, low grade fever
-increased incidence of cancer in SI and colon
Symptoms:
Usually begins with intermittent attacks of mild diarrhea, fever, abdominal pain
Asymptomatic periods
Recurrent attacks or flare ups of diarrhea
-can present abruptly with RLQ pain

Complications: fibrosing strictures, fistulas, gallstones, malabsorption, CRC

Extraintestinal:
-migrating polyarthritis, kidney stones

27
Q

What is the gross anatomy in Crohn’s disease

A
  • May occur at any point along the GI tract
  • Usually affects terminal ileum, ileocecal valve, cecum
  • mucosa show linear ulceration and fissure formation
  • segmental involvment sparing other areas
  • serosal creeping fat
  • cobblestoning
  • fistula with bladder
28
Q

Crohn’s disease histology

A
  • Transmural inflammation
  • cryptitis-crypt abscesses
  • ulceration
  • non caseating granulomas
29
Q

Ulcerative Colitis Clinical

A

Autoimmune
Symptoms:
-relapsing attacks of BLOODY mucoid diarrhea with pain
-recurs after asymptomatic interval
-may have an explosive initial attack with serious bleeding to constitute a medical emergency
Complications: primary sclerosing cholangitis, CRC, toxic megacolon, malnutrition

Extraintinal: primary sclerosing cholangitis

30
Q

What is the gross anatomy of ulcerative colitis?

A

Inflammation primarily involving the mucosa of the colon

  • diffuse continuous inflammation that begins in the rectum and progresses proximally
  • pseudopolyps
  • loss haustra
31
Q

Ulcerative colitis histology

A

Early Phase: neutrophils and crypt abscesses
Later phase: mucosal ulcerates and pseudopolyps form
Late Phase: atrophy and possible dysplasia

-increased risk of colon carcinoma

  • NO granulomas
  • ONLY in mucosa/submucosa not transmural

MHD (81 decks)

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