Unit 4 - GI pt 2

Question 1

diseases of the small bowel (duodenum, jejunum, ileum) fall under 2 categories:

Answer 1

1. malabsorption syndrome

2. obstructive syndrome

Question 2

malabsorption syndrome

Answer 2

You don’t absorb enough from your GI tract in the way of nutrition, vitamins and other essentials to keep your physiology working properly

sudden weight loss

Question 3

causes of malabsorption

Answer 3

GI Surgery (for example gastrectomy, duodenectomy, or jejunectomy)
Hepatobiliary/Pancreatic Disease
GI Lymphoma  (MALT)
Lactase Deficiency (Lactose Intolerance)
GI Infections (Rotavirus, Norovirus)
Sprue (celiac disease)

Question 4

Crohn’s as a cause of malabsorption syndrome

Answer 4

Regional Enteritis
Autoimmune Disease-Terminal Ileum
Full Thickness of the Intestinal Wall
Enteropathic Arthritis

Question 5

s/s malabsorption syndrome

Answer 5

Weight loss
Diarrhea
Steatorrhea (Fatty Stools)
Flatulence
Nocturia
Fatigue
Anemia (B12, Folic Acid B9)
-Pernicious Anemia
-Folic Acid Deficiency Anemia
-Both are Megaloblastic Anemias Anemia
Neuro issues (B12)
Bruising (Ecchymosis)

Question 6

Obstructive syndrome

Answer 6

You cannot pass anything though your intestine due to a blockage

loss of peristalsis
presence of a tumor
volvulus (bowels twists upon itself)

Question 7

obstructive syndrome - Hirschsprung’s disease or senile ileum

Answer 7

congenital megacolon
-Myenteric plexus (Auerbach’s) is absent
-Submucosal plexus (Meissner’s) is absent
bowel is enlarged and static

dysmotility of bowel due to age
Myenteric/Submucosal plexus degeneration
Seen in the elderly

Question 8

obstructive syndrome - paralytic ileus

Answer 8

Parasympathetic Loss to the Lower Bowel (S2-S4)

Question 9

obstructive syndrome - mechanical obstruction

Answer 9

in a volvulus and intestinal neoplasia

Question 10

obstructive syndrome - intussusception

Answer 10

segment of the bowel “telescopes” upon itself

Question 11

obstructive syndrome - “organic” obstructive disease

Answer 11

-

Question 12

s/s obstructive

Answer 12

“Cramping” Abdominal pain
Abdominal distention and bloating
Nausea &Vomiting
Alternating Constipation/Diarrhea

Question 13

complications of obstructive

Answer 13

Fecal Impaction
Bowel Necrosis
Bowel Rupture

Question 14

s/s of intestinal disorders of the colon

Answer 14

\+Dysfunctional Symptoms
“Cramping” Colicky pain
Constipation
Diarrhea
Altered stool size/color
Hematochezia - bleeding polyp

Question 15

appendicitis

Answer 15

(Inflamed Appendix)
Fecalith Etiology - bits of dried stool that go into lumen of appendix
Unknown Etiology

all age groups

Question 16

s/s appendicitis

Answer 16

mcburney’s point (blumberg’s sign) - rebound pain in LRQ

nausea, vom, fever

Question 17

complications appendicits

Answer 17

• Rupture with Peritonitis
• Intra-abdominal hemorrhage
• Intra-abdominal adhesions

Question 18

Diverticulosis (and where it mostly occurs)

Answer 18

Aging-Weakness in the Bowel Wall

90% occur in the Sigmoid Colon

Question 19

Diverticulitis

Answer 19

-Inflammation of a Diverticulum

s/s:
Hematochezia
Elevated WBC’s (PMN’s)
Abdominal pain
Fever
Obstruction

Question 20

potential outcomes of diverticulitis

Answer 20

• Resolution
• Bleeding
• Necrosis
• Rupture

Question 21

Idiopathic Ulcerative Colitis (IUC)

Answer 21

Autoimmune disease
Females > Males
Jewish ancestry

Mucosa Only
Hematochezia
Abdominal Cramps and Severe Pain
Ileus and Obstruction

Question 22

Ulcerative colitis with

Toxic Megacolon

Answer 22

the large, dilated colon protruding through a surgical incision.
May:
-Become Obstructive
-Become Ischemic 
-Become Necrotic
-Rupture

Question 23

colon - Clostridium Difficile

Answer 23

2%-5% Colonization
Infection results in Pseudomembranous Colitis
Diarrhea (severe and protracted)
Abdominal pain (intense)
Flu-like (Constitutional) Symptoms
Often follows administration of antibiotics
Most often affects patients >65
Infection is usually hospital based (nosocomial

Question 24

Carcinoma of the Colon - locations and s/s

Answer 24

65% rectosigmoid colon
35% ascending or transverse colon

s/s:

• Hematochezia (occult)
• Colicky pain
• Weight loss
• Anemia
• Alternating Diarrhea/Constipation
• Obstruction with Abdominal Distention

Question 25

Irritable Bowel Syndrome (IBS)

Answer 25

most common bowel disorder (also called spastic colon)

• Alternating Hyperactivity/Spasm/Sluggishness
• Alternating Constipation/Diarrhea
• Abdominal Discomfort
• May be episodic
• Idiopathic