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48 Cards in this Set
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- Back
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Diverticula in jejunum and ileum
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-mesenteric border at sites of penetration of blood vessels
-outpouching, problem occurs when contents get inside -> does not move around -> statis -causes stenosis, bacterial overgrowth, malabsorption, ulceration and bleeding |
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*Meckel Diverticulum
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-occurs in ileum, ~1-3 ft from ileocecal valve
-heterotopic gastric mucosa in ~50% -acid sec--> PU w/ bleeding -abnL tissue in outpouching |
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***Heterotopic Pancreatic Tissue
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-small masses of pancreatic tissue, <2 cm
-present anywhere in SI, MC duod -MIMICS TUMORS |
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Malabsorption Syndromes
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-whatever you need is NOT absorbed and all of what you need is going OUT
-steatorrhea: bulky (elephant droppings), greasy (fat not absorbed), foul smelling |
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What is Steatorrhea
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-NOT just fat, it has vitamins, minerals, carbs, proteins
-all of which are LOST to our individual nutrition |
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What causes malabsorption syndromes?
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-defective digestion, absorption, transport
-can be due to any one or a combination of them ***MCC in USA --> Celiac disease, Crohn disease, and pancreatic insufficiency |
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***Celiac Disease
(aka Celiac sprue, Gluten-Sensitive Enteropathy) |
-malabsorp due to villous atrophy of jejunal mucosa (MC proximal)
-villi are destroyed b/c of gluten sensitivity, atrophy and die off -immune rxn to gliadin (glycoprotein in gluten) |
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***Celiac disease is the MCC of ____ in the US?
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-"flat biopsy"
-put in scope and biopsy and you see flat intestine instead of villi, greatly decreases SA from a football field to a table surface |
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What are complications of Celiac disease?
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-ulcerations, strictures (high mortality)
-iron and vitamin deficiencies -Inc risk of GIT lymphoma |
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What is blind loop syndrome?
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-bacteria overgrowth in the area
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Tropical Sprue
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-mainly tropical 3rd world regions
-etiology unknown, morphology variable -terminal ileum usually affected -lymphos and eosinos in lamina propria |
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***Whipple Disease (aka Intestinal Lipodystophy)
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-Multi-system disease
-Etiology: caused by Tropheryma whippelii (G+ actinomycete) -white M:F 10:1, 40-50 y/o |
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***Morphology of Whipple Disease
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-SI villi are distended by numerous foamy macrophages laden w/ granules can be stained w/ PAS (will see in biopsy)
-ymphatic obstruction, lipids in lymph nodes |
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What are clinical presentations of Whipple disease?
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-malabsorption, diarrhea, steatorrhea, abd cramps, wt loss and polyarthritis
-systemic symptoms as well |
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Lactase Deficiency
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-disacchrides can't be digested b/c of absence of enzyme
-allergy to milk? -osmotic diarrhea and malabsorption -may appear w/ viral and bact infxn of GIT |
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Abetalipoproteinemia
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-familial form of malabsorption (inborn error of metab)
-diarrhea, steatorrhea and FAILURE TO THRIVE -absorp and transport of food is very difficult |
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***What is possibly the greatest cause of intestinal obstruction?
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-acquired MOSTLY from surgery
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***What are 4 major causes of intestinal obstruction?
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1. Hernias
2. Adhesions 3. Intussusception 4. Volvulus 1-4 are 80% of causes*** |
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Intestinal obstruction:
Hernia |
-Inguinal (MC), femoral, umbilical, surgical scars in abd
-***incarceration, strangulation, gangrene |
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What happens in a constrictive hernia ring?
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-the venous return is restricted as well and food cannot go through the obstructed area (incarcerated area)
-eventually if it becomes VERY tight then the arterial supply will become restricted (infarction) |
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Intestinal obstruction:
Adhesions |
-after peritonitis, previous operations
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Intestinal obstruction:
Intussuseption*** |
-invag of prox portion of the intest into the lumen of the immediately distal segment
-draws in the mesentery and blood vessels are obstructed--> infarction of trapped bowels |
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Intussuseption: Adults vs Children
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-MC in children, often occurring spontaneously
-in adults a benign tumor is usually present at the leading edge of intussuspetion |
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Intestinal obstruction:
Volvulus |
-twisting of loop of Bowel...Gangrene
-commonly in SI or sigmoid colon |
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Ischemic Bowel Disease
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-decrease blood flow to SI
-Acute Intestinal Ischemia (AII) is the MC--> mucosal necrosis to transmural infarction -chronic intest ischemia is less common |
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Acute Intestinal Ischemia (AII)
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-Superior Mesenteric Artery (SMA) occlusion is the MCC
-thrombosis--> atheroma, arthreitis, aneruysm -embolism--> cardiac thrombi, ID, NBTE, valvular prosthesis -nonocclusive - MI, shock, CHF |
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***Mesenteric Venous Thrombosis
Example in Portal Vein Thrombosis |
-pylephlebitis (inflammation of the portal vein)
-this may also give rise to ischemic bowel disease (not just artery obstruction) |
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Morphology of obstructed artery
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-depends on the size occluded
-infarcted segment dusky, purple-red, moist, dilated *nonocclusive hypoperfusion usually cuases mucosal infarction only |
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What does peristalsis dysfunction cause?
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-adynamic ileus --> leads to peritonitis and septicemia
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Chronic Intestinal Ischemia
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-major cause is atherosclerosis of main arteries
-recurrent pain often called celiac compression syndrome -can lead to SI stricture formation--> intest obstruction |
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Inflammatory Bowel Disease (IBD)
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-Etiology: (1) infectious diseases, (2) noninfectious conditions, or (3) idiopathic IBD
-***must rule out 1 or 2 before dx pt w/ Idiopathic IBD |
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***What are the 2 major disorders of Idiopathic IBD?***
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1. Crohn's Disease (CD)
2. Ulcerative Colitis (UC) -*UC is more common in US and may lead to colon cancer -***diseases are different but 10-20% of cases even after biopsy can't differentiate*** -->INDETERMINATE COLITIS |
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Crohn's Disease
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-spreads from mouth to anus
-MC is terminal ileum (Regional ILEITIS) and colon (Granulomatous Colitis) |
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Crohn's Disease Morphology
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-segment/discontinous "skip areas"
-transmural involve of all layers and mesenteric fat over serosal surface ("creeping fat" -"string sign" on Xray -elongated ulcers forming deep fissures --> fistulas |
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Crohn's Disease Malabsorptions
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-protein losing enteropathy
-*not just in the intestines -Extraintestinal manifestations: pericholangitis, amyloidosis, stomatis, arthritis, iritis, etc |
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Ulcerative Colitis (UC)
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-mainly in industrialized countries - exact etiology is unknown
-mainly in colon and rectum, start in rectum and extend backwards -CONTINUOUS LESIONS |
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Ulcerative Colitis (UC)
Morphology |
-"backwash ileitis" - 10% showing involvement of terminal ileum
-ulceration, hemorr, pseudopolyps -Crypt abscess...metaplasia, dysplasia |
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Ulcerative Colitis (UC)
Acute Attack |
-may be very severe, electrolyte imbalance
-severe chronic ulceration may result in colonic dilation and systemic toxicity (TOXIC MEGACOLON) |
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Ulcerative Colitis (UC)
Complications |
-development of Carcimoma 1% in 10 yrs --> >30% at 30 yrs
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***"Make a note" CD vs UC
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-***in CD wall is very thickened, happens only in segments, but in btwn are normal ("skip areas"), the lumen is then very narrow, is called a "rat tailing" effect
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Complications of IBD
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-arthritis, iridocytlitis, anemia, stomatitis, skin lesions, liver/heart damage
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***Tumors of SI:
Benign |
-rare (leiomyoma, neurofibroma, adenoma)
-Peutz-Jeghers syndrome: hereditary GI polyposis a/w excessive melanin pigmentation |
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Tumors of SI:
Malignant |
-Carcinoid, lymphoma, adenocarcinoma (will go around the wall of the SI and cause obstruction...if present MUST perform surgery)
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***Carcinoid Tumor
(Neuroendocrine Tumor) |
-**Can give you carcinoid syndrome
-*low malig (~50% of CA of SI) -all are LOCALLY invasive -*Ileum, colon, stomach freq metast to the liver -appendix and rectum seldom metast |
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Clinical aspects of Carcinoid Tumor
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-majority asymptomatic
-may cause bleeding, intest obstruction, intussusception -may secrete hormones, MC SEROTONIN -cause carcionid syndrome, cushing, ZE syndrome |
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***Carcinoid Syndrome
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-NOTE: righ side of heart to lungs then NOT to the left side bc monoimunoxidase destroys the serotonin
-serotonin only affects the RIGHT sided valves (tricuspid and pulmonic valves) |
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***Symptoms of Carcinoid syndrome
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-face flushing, bronchoconstrict -VHD: TV and PV
-Liver: metastases -Blood: increase in serotonin that is decarboxylated in liver--> ***Urine 5-HIAA present, excreted |
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***How does one diagnose Carcinoid syndrome?
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-send urine to lab, the serotonin is metabolized and 5-HIAA is found in the urine
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