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34 Cards in this Set
- Front
- Back
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What are some of the ways small bowel pathology can present?
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Diarrhea, from lots of dif causes
Pain will be colocky = cramping, intermittent Anemia, Edema, Symptoms related to fat-soluble vit. def. (ADEK), distention, flatulence |
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Pt presents with persistent vomiting. What congenital small intestine disorder could be present?
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Atresia or stenosis
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Define meconium ilues
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neonate intestinal obstruction by mecoium.
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Pathogenesis of meconium ileus in cycstic fibrosis?
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CF = def. in pancreatic enzymes = INC. viscosity of secretions
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Define Meckel Diverticulum
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Persistence of omphalomesenteric (vitelline) duct which connects yolk sac to midgut
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What are the rule of 2's with Meckel Diverticulum?
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Occurs in 2% of population
2 inches long 2 feet within ileocecal valve 2% symptomatic 2 y/o |
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T/F: Sm. intestine has relatively small numbers of bact. compared to lg. intestine
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TRUE
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What are the two types of vascular disorders of the sm. intestine?
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Mural and Transmural
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Define Mural vascular disorder of sm. intestine
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HypOperfusion ie NOT all of the full thickness of the sm. intestine is hypoperfused with blood (vs. transmural = the full thickness of the sm. intestine is under-perfused)
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Define Transmural vascular disorder of the sm. intestine
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the full thickness of the sm. intestine is under-perfused with blood
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What are the most common cause of obstructions in sm. intestine?
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adhesions
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Hernias, IBD, Duodenal Atresia, and Intusssuception can all cause what?
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sm. intestine obstruction
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Pathogenesis of malabsorption?
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Pancreatic insufficiency
Bile salt insuff. Bact. Overgrowth Celiac dis. Whipple dis. Tropical Sprue Short Bowel Syndrome |
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What are some of the things that predispose a pt. to small bowel bact. over-growth?
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stasis and entero-enteric fistulas
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Pathogenesis of short bowel syndrome?
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Removal of significant portion or region of sm. bowel = less than 200cm sm. bowel remain = loss of absorptive surface area = B12 and bile salts absorbed in terminal ileum - loss of enteric hormonal signaling = CAN lead to bact. overgrowth
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Mucosal brush border disaccharidases and oligopeptidases defects can lead to what?
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Lactase deficiency
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Define Abetalipoproteinemia
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Auto. recessive
defect in synth and transport of apoprotein B from enterocytes - form lipid vacuole |
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Define celiac disease
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Gluten-sensitive enteropathy
= aberrant immune response to gluten present in certain cereals and their products |
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Pathogenesis of celiac disease?
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Generalized Malabsorption from immune-mediated alteration of structure of sm. bowel mucosa
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Which HLA's are assoc. with celiac disease?
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HLA-B8, HLA-DR8, HLA-DQ2
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Pts with celiac disease will have inc. or dec. IgA?
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INC
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CBC shows elevated anti-tissue transglutaminase (tTG) IgA. What does pt have?
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Celiac disease
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When we do a biopsy for celiac dis. what do we expect to see?
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Villous blunting (flattening) with intraepithelial lymphocytes (CD8 and CD4 T cells)
Dense plasma cell infiltrate in lamina propria |
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How will pts with celiac disease present?
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Celiac dis = malabsorption problem, so they will have weight loss, steatorrhea, failure to thrive, Vit. deficiencies, folate B12 and Calcium deficiencies
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Pt presents with dermatitis herpteformis ie itchy rash of bumps and blisters all over. What underlying condition could they be suffering from?
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Celiac disease
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Tx. for celiac dis?
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Gluten-free diet for all of time.
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Define Whipple's disease
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Intestinal Lipodystrophy
from: Tropheryma whippelii = robdshaped bact. = Infiltrate mucosa and pahgocytosed by macrophages which pack the lamina propria of the villi |
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How does Whipple's disease present?
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Systemic illness: fever, anemia, lymphadenopathy, arthritis, CNS, pericarditis, endocarditis, skin pigmentation
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Whats the pathology behind Whipple's disease?
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Caused by a bact. so abundant macrophages in lamina propria with PAS-positive granules (lysosomes containing bact.)
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Define Tropical Sprue
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May be due to e. coli or Haemophilus
Injury to entire small bowel --> malabsorption following acute diarrheal episode |
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Whats the most common neoplasm of sm. intestine?
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Adenocarcinoma
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What are the benign sm. bowel neoplasms?
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Adenoma, Peutz-Jehger polys, Leiomyomas, Lipomas
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Whats the second most common sm. bowel neoplasm
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Lymphoma (MALT, Non-Hidgkins, Burkitt, Enteropathy-associated T-Cell lymphoma)
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T/F: All sm. bowel carcinoid tumors are considered potentially malignant
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TRUE
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