Zaman 12-21-07 Gi-3 Small Bowel

Front 1

The student will learn and be able to discuss: definition,
pathogenesis, clinical course, gross and microscopic
pathology, and complications of:
Malabsorption
Carcinoid and other tumors
Pneumatosis cystoides intestinalis
Bowel ischemia/ infarction
Bowel obstruction
Peritoneal disease
2

Back 1

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Front 2

Celiac sprue =non-tropical sprue = gluten-sensitive
enteropathy
Sensitivity to g______ in gluten (in wheat, barley, and rye
grains and flours made from them)
Microscopically:
Blunting of villi -->atrophy and flattening of mucosa
Mononuclear cells in lamina propria
Hyperplasia in crypts
1:2000 Caucasians, but is rarely seen in other races.
Over 95% of affected patients will express the HLA __
& DQw2 MHC antigen, which suggests a genetic basis.
Association with dermatitis herpetifomis (HLA __),
vesicular skin disease of extensor surfaces.
Clinically: excellent response to avoidance of gluten in
diet. However, gluten is found in many foods and is hard
to avoid.

Back 2

1:2000 Caucasians, but is rarely seen in other races.
Over 95% of affected patients will express the HLA B8
& DQw2 MHC antigen, which suggests a genetic basis.
Association with dermatitis herpetifomis (HLA B8),
vesicular skin disease of extensor surfaces.
Clinically: excellent response to avoidance of gluten in
diet. However, gluten is found in many foods and is hard
to avoid.

Front 3

Meckel's diverticulum (aka _% anomaly)
1/2 have gastric mucosal rests, can have associated
ulcers
about _% of people have them; they are usually
located _ feet from the ileocecal valve.

Back 3

Meckel's diverticulum (aka 2% anomaly)
1/2 have gastric mucosal rests, can have associated
ulcers
about 2% of people have them; they are usually
located 2 feet from the ileocecal valve.

Front 4

Tropical Sprue treated with ___________
and Folic acid

Back 4

Tropical Sprue treated with Doxycycline
and Folic acid

Front 5

The most common neoplasm in small bowel is a __________

Back 5

The most common neoplasm in small bowel is a metastasis

Front 6

Carcinoid (neuroendocrine tumors)
Intensely vascularized tumors follow the "rule of one ______,":
1/_ of the tumors are multiple, 1/_ of those in the GI tract are
located in the small bowel, 1/_ have a second malignancy, and
1/_ metastasize.

Back 6

Carcinoid (neuroendocrine tumors)
Intensely vascularized tumors follow the "rule of one thirds,":
1/3 of the tumors are multiple, 1/3 of those in the GI tract are
located in the small bowel, 1/3 have a second malignancy, and
1/3 metastasize.

Front 7

Carcinoid (neuroendocrine tumors)

Some of the tumors produce hormones excessively, causing a
condition known as _________ carcinoid syndrome.

Back 7

Carcinoid (neuroendocrine tumors)

Some of the tumors produce hormones excessively, causing a
condition known as malignant carcinoid syndrome.

Front 8

Carcinoid clinical course:
Morbidity is related to vasoactive _____ production.
Survival rate usually correlates inversely with the levels of
daily urinary 5-____ excretion, high plasma levels of
neuropeptide K, chromogranin A, the location of the tumor,
the stage of the disease, and a second malignancy.

Back 8

Carcinoid clinical course:
Morbidity is related to vasoactive amine production.
Survival rate usually correlates inversely with the levels of
daily urinary 5-HIAA excretion, high plasma levels of
neuropeptide K, chromogranin A, the location of the tumor,
the stage of the disease, and a second malignancy.

Front 9

Carcinoid syndrome
Paroxysmal flushing; episodes of asthma-like
wheezing; _____-sided heart failure; attacks of
explosive, watery diarrhea; abdominal pain; edema
due to _________ excess with some contributions
from substance _, histamine, bradykinin
Classically seen with ileal carcinoids

Back 9

Carcinoid syndrome
Paroxysmal flushing; episodes of asthma-like
wheezing; right-sided heart failure; attacks of
explosive, watery diarrhea; abdominal pain; edema
due to serotonin excess with some contributions
from substance P, histamine, bradykinin
Classically seen with ileal carcinoids

Front 10

Necrotizing Enterocolitis (NEC)
The most common gastrointestinal medical and/or surgical
emergency occurring in ________. Mortality rates of 50%
in _______ less than 1500 g.

Back 10

Necrotizing Enterocolitis (NEC)
The most common gastrointestinal medical and/or surgical
emergency occurring in neonates. Mortality rates of 50%
in infants less than 1500 g.