Podcast
Questions and Answers
What is a common characteristic of Whipple disease?
What is a common characteristic of Whipple disease?
Which of the following bacteria is associated with infectious enterocolitis?
Which of the following bacteria is associated with infectious enterocolitis?
Which of the following statements about malabsorption disorders is true?
Which of the following statements about malabsorption disorders is true?
What is indicative of an infectious enterocolitis caused by Enteroinvasive E. coli?
What is indicative of an infectious enterocolitis caused by Enteroinvasive E. coli?
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What is the primary complication associated with Typhoid fever?
What is the primary complication associated with Typhoid fever?
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Which complication is commonly associated with Crohn disease?
Which complication is commonly associated with Crohn disease?
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What is a characteristic feature of intussusception?
What is a characteristic feature of intussusception?
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Which of the following extraintestinal manifestations is linked to Crohn disease?
Which of the following extraintestinal manifestations is linked to Crohn disease?
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Which statement correctly describes ulcerative colitis?
Which statement correctly describes ulcerative colitis?
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What is a common clinical presentation of carcinoid syndrome?
What is a common clinical presentation of carcinoid syndrome?
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What is a characteristic of Celiac disease?
What is a characteristic of Celiac disease?
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What is the most common site of atresia and stenosis in the bowel?
What is the most common site of atresia and stenosis in the bowel?
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Which of the following statements regarding Meckel's diverticulum is true?
Which of the following statements regarding Meckel's diverticulum is true?
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Which type of anemia is commonly associated with Celiac disease?
Which type of anemia is commonly associated with Celiac disease?
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What is the Rule of 2's related to?
What is the Rule of 2's related to?
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What feature is noted in the morphology of Celiac disease?
What feature is noted in the morphology of Celiac disease?
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Which condition is commonly classified under neoplasms of the small bowel?
Which condition is commonly classified under neoplasms of the small bowel?
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What is the primary causative agent implied in tropical sprue?
What is the primary causative agent implied in tropical sprue?
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Study Notes
Disorders of the Small and Large Bowel
- The small intestine measures approximately 6 meters in length.
- The first 25 cm of the small intestine, the duodenum, is retroperitoneal.
- The first one-third of the intraperitoneal part of the small intestine is the jejunum.
- The remainder of the small intestine is the ileum.
- The arterial supply to the small intestine is the superior mesenteric artery.
Disorders of the Small Bowel
Non-Neoplastic Disorders
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Congenital Anomalies
- Heterotopic gastric mucosa
- Heterotopic pancreas
- Meckel's diverticulum
- Malrotation, stenosis, atresia, duplication, and defects of musculature
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Malabsorptive disorders
- Celiac disease
- Characterized by malabsorption, abnormal small bowel structure, and intolerance to gluten.
- Pathogenesis involves sensitivity to gluten protein components of wheat, oats, barley, and rye.
- Immune-mediated response.
- Associated with increased milk intolerance, diabetes, ulcerative colitis, and primary sclerosing cholangitis.
- Morphology shows diffuse enteritis, atrophy/loss of villi, and increased intraepithelial lymphocytes
- Tropical sprue
- Celiac-like disease affecting people in tropical regions.
- No specific causative agent identified but may involve E. coli and Hemophilus.
- Pathology ranges from normal to diffuse enteritis
- Malabsorption, but no risk of intestinal lymphoma.
- Treated using antibiotics.
- Whipple disease
- Rare systemic disease, Hallmark is distended macrophages in the lamina propria of the small intestine (mostly jejunum).
- Inflammation is absent at the site of infection.
- Mostly affects males aged 30-40.
- Often an atypical presentation, with >50% incidence of lymphadenopathy and skin hyperpigmentation.
- Celiac disease
-
Infectious Diseases
- Infectious enterocolitis
- Common gastrointestinal viruses (Rota virus, Norwalk virus, enteric virus).
- Bacterial pathogens (E. coli, Salmonella, Campylobacter, Vibrio cholera, Clostridium perfringens, Enteroinvasive E. coli, Shigella).
- Post-infectious complications, like reactive arthritis, Guillain-Barré syndrome, immune-proliferative small intestinal disease, can occur with Campylobacter infection.
- Parasitic diseases
- Giardiasis does not cause villus architectural changes.
- Diagnosis involves microscopic identification of pear-shaped trophozoites using trichrome/Giemsa stains.
- Other parasitic diseases include Ascaris lumbricoides and Strongyloides.
- Typhoid Fever (Salmonella typhi and paratyphi)
- Acute infection, associated with bloody diarrhoea and flu-like symptoms.
- Morphology shows enlarged Peyer's patches in the terminal ileum, with oval ulcers oriented along the ileum's long axis
- Complications include bacteremia and extra-intestinal involvement.
- Infectious enterocolitis
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Crohn disease and acquired diverticula
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Polyps
Neoplasms
- Polyps
- WHO classification of tumors
Acquired Diverticula
- False diverticula
- Increase with age
- Most common site is the duodenum
- Pathophysiology involves bacterial overgrowth, leading to periampullary diverticula that cause obstructive jaundice and intestinal obstruction.
Polyps and Neoplasms
Benign Tumors
- Adenomas (commonest benign neoplasm)
- True adenomas (ileum), are usually asymptomatic but may cause bleeding and obstruction.
- Villous adenomas (duodenum), with no malignant potential.
- Brunner's gland adenoma (duodenum)
- Leiomyoma (most common symptomatic benign lesion, usually causing bleeding)
- Lipoma (most common in ileum, causes obstruction)
- Peutz-Jeghers polyps (autosomal dominant; multiple polyps in the GIT; jejunum/ileum are the frequent sites; mucocutaneous melanotic pigmentation but no malignant potential)
Malignant Tumors
- Adenocarcinoma of the small bowel
- Rare (2% of primary GIT tumours)
- Predominantly occurs in the duodenum.
- Carcinoid Tumour
- Accounts for >50% of malignant tumours in the small intestine.
- Arises from Enterochromaffin/Kulchitsky cells.
- Malignant potential varies with the location (e.g., appendicular vs. ileal)
- Possible metastasis (e.g., lymph nodes, liver).
Intestinal Obstructions
- Hernia
- Adhesions
- Intussusception
- Volvulus
Intussusception
- Definition: A portion of the bowel invaginates into an adjacent section
- Typically occurs in children under 5 due to lymphoid hyperplasia
- Older patients may have intra-luminal tumors
- Potential complications include ischemic necrosis.
Diverticulosis
- Characterized by the presence of small pouches in the intestinal wall
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Description
Explore the various disorders affecting the small and large intestine, including congenital anomalies and malabsorptive disorders. This quiz covers the anatomy, pathology, and management of gastrointestinal conditions, with a focus on the small bowel disorders such as Celiac disease and others. Test your knowledge on these critical aspects of gastrointestinal health.
