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25 Cards in this Set
- Front
- Back
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Paneth Cells
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have zymogen granules with pro-enzymes
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endocrine cells release...
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gastrin, secretin, CCK, glucagon, VIP, serotonin
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3 major functional features of the small bowel?
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Absorption (99% of water)
Digestion Defense (IgA immune cells) |
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mother brings child in with recurring green like vomit.What is going on?
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Congential disorder: Atresia/stenosis
typically distal to the ampulla |
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if a newborn has meconium ileus (what is this?) what is something you really need to worry about
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Neonatal intestial obstruction=Meconium ileus
worry about: Cystic fibrosis: deficiency of pancreatic enzymes and increased viscosity of secretions Volvulus, perforation with meconium peritonitis |
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What is Meckel diverticulum and the Rule of 2's associated with it?
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True diverticulum: persistence of omphalomesenteric (vitelline) duct
Connects yolk sac to primitive midgut Small bulge in small intestine Occurs in 2% of population; 2 inches long; 2 feet within ileocecal valve; 2% symptomatic; 2 yo 2 x more males |
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what are the 2 types of bowel ischemia and what is associated with them? what are the Sx like?
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Transmural (full thickness)
--assoc with Thromboemobolism, get blood diarrhea with acute pain Mural (mucosal) --Hypoperfusion/hypovolemic shock -associated with HF or MI -pt has intermittent pain |
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What is the most common cause of obstruction? what is the cause?
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fibrosis and scarring leading to ADHESIONS of adjacent bowel segments
normally due to previous abdominal surgery |
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what is intussusception? how does it differ in adults and children
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telescoping of bowel
Mucosal / submucosal “lead points” --Children: lymphoid --hyperplasia of Peyer’s patches Adults: mass (neoplasm) |
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what can bacteria do in Small bowel bacterial overgrowth that leads to malabsorption/diarrhea? What predisposes a person to having bacteria in their small bowel?
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deconjugate bile, leading to improper fat absorption
Predisposition: stasis (IBD, adhesions, motility disorders); entero-enteric fistulas Malabsorption: diarrhea, weight loss |
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What is short bowel syndrome? when is it truly problematic?
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Removal of significant portion or region of small bowel (and/or colon)
< 200 cm of small bowel remain (< 1/3) -->Problematic |
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pt has abdominal distension, flatus, "explosive" osmotic diarrhea... what do they have?
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Mucosal brush border deficiency: namely LACTASE deficiency
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What happens in Celiac disease?
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Aberrant immune response to gluten present in certain cereals and their products(Wheat, barley, rye)
Generalized malabsorption from immune-mediated alteration in structure (and hence function) of small bowel mucosa Structural alteration: flattened mucosa from villous blunting |
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What is the genetic predisposition in Celiac disease?
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HLA-B8 and HLA DQ2
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what are associated autoimmune disorders seen with celiac disease (this could be a 3rd order style question)
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DERMATITIS HERPETIFORMIS
Others include: Hashimoto’s thyroiditis; primary biliary cirrhosis; type 1 DM IgA deficiency |
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what mediates the response to celiac disease?
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IgA
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Key diagnostic feature to Celiac Disease?
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serum testing showing Anti-tissue transglutaminase (tTG) IgA
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what is different in the histology of celiac disease
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vili are flattened and broadened rather than finger like projections
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pt presents with fever; anemia; lymphadenopathy; arthritis; CNS involvement; pericarditis; endocarditis; skin pigmentation. The lamina propria is found to have tons of macrophages and is PAS positive. What do they have?
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Whipple’s Disease
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Tropheryma whippelii
Rod-shaped bacterium (actinomycetes) Infiltrate mucosa and phagocytosed by macrophages, which pack the Lamina Propria of the villi Cause villous expansion/blunting Obstruct lymphatics (lacteals) |
Whipple’s Disease
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this is an infectious process due to haemophilus or E coli, causing injury to ENTIRE small bowel, with various villous atrophy. This leads to malabsorption and acute diarrhea.
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Tropical Sprue
person will be from Caribbean |
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this is an Autosomal dominant disease that causes intestinal hamartomatous polyps (benign) and mucocutaneous melanotic pigmentation. It can lead to obstruction and intussusception. What is this? and what can it lead to increased risk of?
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Peutz-Jehger polyps (benign)
Increased risk of cancers in breast, pancreas, testis, ovaries |
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most common small bowel neoplasia?
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adenocarcinoma
near the ampulla of the bile duct note: only 2% of GI malignancies occur in small bowel |
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what malignancy is associated with Celiac disease?
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Enteropathy-associated T-cell lymphoma
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• Rare, autosomal recessive: defect in synthesis and transport of apoprotein B from enterocytes – form lipid vacuoles
- Cannot form chylomicrons • Failure to thrive, steatorrhea / diarrhea |
Abetalipoproteinemia
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