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89 Cards in this Set
- Front
- Back
How do bowel duplications present?
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abdominal mass, bouts of pain due to obstruction, intussusception, perforation
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What happens with bowel duplication?
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cystic or saccular masses attached to mesenteric side fo bowel
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Where is the most common site of bowel duplication?
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ileocecal valve
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Why does malrotation of the gut happen?
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disordered/interrupted rotation of the gut around SMA
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How does malrotation of the gut present?
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signs and symptoms of bowel obstruction
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What causes an omphalocele?
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anterior ab wall fails to develop, born with abdominal contents outside of ab cavity, viscera covered with peritoneal membrane
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What happens in gastroschisis?
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part of abdominal wall doesn't develop abdominal organs outside of peritoneal cavity, uncovered by peritoneal membrane
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What is heterotopia?
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development of normal tissue in abnormal areas
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What happens if you have ectopic gastric tissue?
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ulceration and intestinal bleeding
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What is atresia?
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complete obstructiono f the lumen
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What causes imperforate anus?
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failure of cloacal diaphragm to completely regress
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What causes Mecke's diverticulum?
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failure of vitelline duct to completely involute
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What is in Meckels?
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3 layers of gut
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Where do you find Meckels?
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ntimesenteric side of the bowel proximal to ileocecal valve
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What are the complications of Meckels?
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heterotopic gastric mucosa causing ulceration and bleeding
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Who gets Hirschsprung?
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males iwth Down syndrome
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What causes Hirschsprung?
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migration of neural crest cells stops before reaching distal gut or anus, defective innervation, lack of motility of affect segment
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What happens in Hirschsprung disease?
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functional obstruction, dilation of gut proximal to denervated segmetn
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Who gets pseudomembranous colitis?
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adults iwth acute/chronic diarrhea without preexisting bowel disease, have received one course of broad spectrum antibiotics
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What causes pseudomembranous colitis?
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antibiotics that allow overgrowth of resistant organisms in the colon
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Which pathogens cause pseudomembranous colitis?
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C dif, slamonella, C perfringens, staph aureus
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What does C dif make?
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toxins A & B, damage colonic mucosa stimulate fibrinopurulent exudate
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What does pseudomembranous colitis look like grossly?
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yellow shaggy exudate on reddish mucosa
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What does pseudomembranous colitis look like microscopically?
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pseudomembranes adherent to surface of the mucosa, looks like erupting volcano, lamina propria has neutrophilic infiltrate with fibrin thrombi in capillary vessels
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How do you treat peudomembranous colitis?
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antibiotic against C dif
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What causes inflammatory bowel disease?
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uncertain, abnormal immune regulation maybe
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What does Crohn's diease involve?
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mouth to anus
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What are the hallmarks of Crohn's?
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granulomas, transmural inflammation, skip lesions
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What is the hygiene hypothesis?
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food processing decreased enteric infections, mucosal immune system can't regulate reaction to intestinal flora, overreaction of the immune response
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Who gets Crohns?
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white Jewish, women
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What reactivates Crohns?
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stress, diet, cigarettes
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Where are the gross features of Crohns?
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segmental involvement of the gut, linear ulcers that start as punctate ulcers, thickened inflexible small bowel wall with narrowed lumen, progressive fibrosis, thickening of bowel wall, get "creeping fat"
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What do you see with colonic Crohns?
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no thickened wall
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Waht is the microscopic pathology of Crohns?
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transmural inflammation, non-casesating grnaulomas, dilation of lymphatics, lymphoid aggregates in all layers of hte bowel, thickened nerve bundles in sub-mucosa, maintained surface mucus production
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What are the local complications of Crohns?
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fistulas, hemorrhage, stricture, malignancy
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What are the systemic complications of Crohns?
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hepatic inflammation, arthritis, ocular inflammation, erythema nodosum of skin, nutritional problems
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Where does ulcerative colitis affect?
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large bowel, never small intestine
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What are the major gross features of ulcerative colitis?
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lesions begin in the rectum, spread proximally, mucosal ulceration with inflammatory pseudopolyps, surface of mucosa looks polypoid, mild bowel wall thickening
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What is backwash ileitis?
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inflammatory reaction in terminal ileum
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What does UC look like microscopically?
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microabscesses in crypts that develop into ulcerations, only mucosa involved
wall can become fibrotic later, pseudopolyps are frequently present |
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What are the local complications of UC?
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toxic megacolon, hemorrhage, stricture, carinoma
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What are the systemic complications of UC?
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hepatitis and pericholangitis, hemolytic anemia, ankylosing spondylitis, migratory large joint arthritis, thromboembolism, uveitis, erythema nodosum, pyoderma gangrenosum
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What features of UC make carincoma more likely?
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long duration, chronic symptoms with multiple recurrences
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What ist he difference in rectal involvement with UC and CD?
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100% of UC, 17% of CD
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What is the difference in distribution with UC and CD?
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UC diffuse, continuous
CD focal, skip areas |
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What is the difference in serosa with UC and CD?
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UC normal
CD fat-wrapping vascular congestion |
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What is the difference in bowel wall thickness with UC and CD?
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UC normal
CD increased in small intestine |
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What is the difference in mucosa between UC and CD?
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UC varies with activity, intense hyperemia pseudopolyps
CD serpiginous ulcers, longitudinal fissures, "cobblestones" |
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What is the difference in small bowel between UC and CD?
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UC "backwash ileitis"
CD involved 85% of the time, stricture formation |
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What is the difference in inflammation between UC and CD?
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UC diffuse mucosal and submucosal
CD focal transmural |
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What microscopic findings do you not necessarily have in CD?
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mucosal atrophy, crypt distortion
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What microscopic findings do you not necessarily find in UC?
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granulomas, lymphoid aggregates, aphthoid ulers, neutral hypertrophy
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What complications do you get in UC but not really in CD?
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toxic megacolon, carcinoma risk
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What complications do you get in CD but not really in UC?
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fistulas, strictures
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What findings do you have in UC but not necessarily in CD?
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rectal involvement, bleeding, remissions, exacerbations
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What findings do you have in CD but not necessarily in UC?
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segmental disease, fistulas, anal disease
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What microscopic findings do you definitely have in UC?
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crypt abscesses, decreased mucin, vascular congestion, mucosal atrophy, crypt distortion
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What microscopic findings do you defintiely have in CD?
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granulomas, lymphoid aggregates, aphthoid ulcers, neural hypertrophy
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What is the large intestine inflammatory difference between UC and CD?
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UC mucosal and submucosal inflammation
CD transmural inflammation, wall not thickened |
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What is the large intestine submucosa difference?
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UC width of submucosa normal or reduced
CD width of submucosa normal or increased, prominent nerve bundles |
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What is the large intestine lymphoid hyperplasia difference?
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UC focal lymphoid hyperplasia in mucosa and superficial submucosa
CD focal lymphoid hyperplasia in mucosa, submucosa, serosa, pericolic, regional lymph nodes |
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What is the difference in "crypt abscesses?"
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UC crypt abscesses very common
CD fewer crypt abscesses |
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What is the difference in large intestine mucus secretion?
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UC grossly impaired mucus secretion
CD slightly impaired mucus secretion |
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What is the difference in paneth cell metaplasia in the large intestine?
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UC paneth cell metaplasia common
CD paneth cell metaplasia uncommon |
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What is the difference in sarcoid granulomas in the large intestine?
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UC usually absent from bowel and lymph nodes
CD 35% of patients have sarcoid-type granulomas in bowel and lymph nodes |
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What's the difference in large intestine fissuring between UC and CD?
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UC absent
CD very common |
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What's the difference in precancerous large intestinal changes in UC and CD?
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UC precancerous epithelial change
CD increased incidence of carcinoma, no precancerous change described |
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What's the difference in anal lesions in UC and CD?
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UC nonspecific anal inflammation
CD granulomatous foci often present |
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What is diversion colitis?
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surgical treatment on intestinal disease leads to creation of a segment of bowel from which fecal stream has been diverted
affected segment has mucosal friability, inflammation, lymphoid hyperplasia that resolve if segment is reconnected and fecal stream returns |
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What is microscopic colitis?
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older patients who presentw ith watery diarrhea
normal studies show increased intra-epithelial lymphocytes, mixed inflammatory infiltrate in lamina propria |
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What is collagenous colitis?
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type of microscopic colitis with a thickened subepithelial collagen layer with separation of overlying epithelium
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Who gets collagenous colitis?
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older females
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What is lymphocytic colitis?
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type of microscopic colitis with a normal sub-epithelial collagen layer, more intraepithelial lymphocytes
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What is associated with lymphocytic colitis?
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celiac disease, lymphocytic thyroiditis, arthritis, autoimmune gastritis
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What causes intestinal graft-versus-host disease?
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donor T cells targeting antigens on epithelial cells throughout the GI tract following allogenic bone marrow transplantation
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What causes transmural infarction?
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occlusion of a major artery
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What is angiodysplasia?
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acquired malformation of hte submucosal and mucosal blood vessels
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Where does angiodysplasia usually occur?
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right colon and cecum
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What causes angiodysplasia?
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mechanical factors and wall tension are highest in cecum, dilated vessels in mucosa are close to the surface
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What are hemorrhoids?
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varicose veins in anal venous plexus, may be due to distal displacement of anal cushions, when supporting tissue of anal cushion disintegrates or deteriorates
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What can cause hemorrhoids?
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straining, pregnanacy, portal hypertension
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What causes diverticular disease?
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high fat, low fiber diet, decreased amount of residue in gut, increased transit time of the stool
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What are diverticula?
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herniations of the mucosa through muscularis at the point of weakness
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Where is the most common site of diverticular disease?
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mesenteric side of sigmoid colon
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What does diverticulitis look like?
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herniations of the mucosa through the muscularis at teh points of weakness
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What are the complications of diverticulitis?
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ifnlammation, fistula, obstruction, bleeding
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Where do intestinal obstructions occur?
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small bowel
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What casues a mechanical adhesion?
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fibrous bands form between bowel segments or abdominal wall
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What can cause adhesions?
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hernias, volvus, intussusception, functional adhesions
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