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47 Cards in this Set
- Front
- Back
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Which portions of the small intestine are frequently biopsied?
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-Duodenum
-Terminal ileum |
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What population is involved in a significant portion of small intestinal pathology?
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Pediatrics
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Re: the Small Intestine:
-How long -3 parts -Where are the first 25 cm? |
6 meters
Duodenum, jejunum, ileum First 25 cm is retroperitoneal |
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What are the histologic layers in the small intestine?
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MMMSMPS
Mucosa, muscularis, mucosa, submucosa, muscularis propria, serosa |
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What is the function of the small intestine?
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Absorption of nutrients thru villi
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What are the 5 major pediatric small bowel conditions?
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1. Duodenal atresia
2. Meckel's diverticulum 3. Intussusception 4. Meconium ileus 5. Necrotizing enterocolitis |
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At what age does Duodenal atresia usually occur?
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0-1 weeks - very early
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At what age does Meckel Diverticulum usually occur?
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0-2 years
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At what age does Intussusception usually occur?
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Older; 4 mo - 2 year
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At what age does Meconium ileus occur?
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0-2 weeks - Very young again
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At what age does Necrotizing enterocolitis occur?
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0-2 mo
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What is duodenal atresia?
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Narrowing/closing off of the small intestine - in the 2nd portion of duodenum.
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How does duodenal atresia present clinically?
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At birth with vomiting of bile stained material
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What does abdominal radiograph reveal in Duodenal Atresia?
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Double bubble sign - gas in the distal bowel / proximal stomach.
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What syndrome is Duodenal atresia associated with?
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30-40% of Down syndrome
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What is the definition of a diverticulum?
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A blind pouch leading off the alimentary tract lined by a mucosa that communicates with the gut lumen.
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What is the cause of Meckel's diverticulum?
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Failure of the Vitiline Duct to involute
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What is the vitiline duct?
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It connects the embryologic gut to the yolk sac
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What is the usual location of a meckel's diverticulum?
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Antimesenteric (opposite side)
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What is a true diverticulum characterized by?
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All 3 layers of normal bowel wall - mucosa, submucosa, muscularis propria
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What would a false diverticulum lack?
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A muscularis layer
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What is seen in 50% of meckels diverticula?
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Heterotopic Gastric or Pancreatic tissue
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What kind of problems arise when gastric or pancreatic tissue is mixed into small intestine tissue?
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Acid / enzyme secretions into the small intestine which is supposed to be neutral; ulceration and pain.
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What are the 5 components of Meckel's Rule of Two's?
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-Within 2 feet of the ileocecal valve
-2% of population -2 in. long -Symptoms in 2% of patients -Presents in first 2 yrs |
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What is Intussusception?
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Telescoping of one segment of proximal bowel into distal bowel
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What is the cause of the wave that results in telescoping?
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Any lead point - peyers patch hyperplasias, tumors, a meckel's diverticulum, any abnormal structure.
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What are the 3 hallmark symptoms of intussusception?
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1. Colicky pain
2. Abdominal distension 3. Currant jelly stools |
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What is currant jelly stools really?
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Clotted blood
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With what disease is Meconium Ileus associated?
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Cystic fibrosis - due to thick exocrine secretions, the meconium can't be pooped out and it leads to obstruction.
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What is Meconium?
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Fetal stools
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What is Necrotizing Enterocolitis?
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Acute necrotizing inflammation of the small intestine
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What are the potential catastrophic consequences of NEC?
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-Transmural necrosis
-Perforation |
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Why is NEC so alarming?
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It is the most common acquired GI emergency in PREMATURE infants
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When is the peak incidence of NEC?
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Peak: 2-4 days when start on oral foods
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What is the cause of NEC?
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Feeding with an immature gut immune system that is not fully developed; causes release of proinflammatory cytokines
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What eventually happens after the pos-feedback type of cycle in NEC?
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Breakdown of the mucosal barrier allows Transluminal migration of bacteria
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What are 3 things that result from transluminal migration of bacteria?
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1. Necrosis
2. Sepsis 3. Pneumatosis intestinalis |
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What is Pneumatosis intestinalis?
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Gas within the wall of the intestine
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What are two general categories of small bowel obstruction in older patient populations?
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-Mechanical
-Nonmechanical |
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What does small bowel obstruction generally present like (if you compare to a pediatric type)?
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Similar to duodenal atresia
-Abdominal pain -Copious vomiting |
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What is Ileus?
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Loss of peristalsis, not due to a mechanical obstruction.
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What is the most common cause of Ileus?
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Post-operative state - just opening up the abdominal cavity and touching it!
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How are both Small bowel obstr. and Ileus treated?
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-Nasogastral intubation to remove the backed up junk
-IV fluids -Operate if severe |
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What is Volvulus?
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Twisting of the bowel around the mesenteric root
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What sequelae can potentially occur with volvulus?
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Obstruction and strangulation with infarction of the small bowel.
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What is the treatment of choice for volvulus?
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Surgery
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What type of clinical findings are seen in all 3 small bowel obstructions (SBO, ileus, and volvulus)?
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Abdominal distention, pain, reduced bowel sounds.
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