Small Bowel Disorders Overview

Questions and Answers

What is the primary role of the villi in the small intestine?

To store intestinal bacteria

To produce digestive enzymes

To regulate bowel movements

To enhance nutrient absorption (correct)

Which of the following is NOT a consequence of loss of function in the small bowel?

Altered bowel transit time

Increased absorption of water (correct)

Nutritional deficiencies

Diarrhoea

Which syndrome is characterized by malabsorption and is caused by a gluten sensitivity?

Coeliac Disease (correct)

Giardiasis

Intestinal atresia

Whipple's Disease

Which condition is most closely associated with the presence of non-caseating granulomas?

Whipple's Disease Signup and view all the answers

What is a common symptom of acute appendicitis?

Localized abdominal pain in the right lower quadrant Signup and view all the answers

Which benign condition is characterized by the presence of a diverticulum near the caecum?

Meckel’s diverticulum Signup and view all the answers

Which of the following is a developmental failure leading to an obstruction of the intestinal lumen?

Stenosis Signup and view all the answers

Which condition is most likely to result in malabsorption of fat-soluble vitamins?

Coeliac Disease Signup and view all the answers

Which of the following symptoms is NOT typically associated with coeliac disease?

Nausea and vomiting Signup and view all the answers

What is the main cause of villous atrophy in coeliac disease?

Autoimmune response to gliadin Signup and view all the answers

Which of the following protozoa is responsible for giardiasis?

Giardia lamblia Signup and view all the answers

What is the consequence of malabsorption syndromes on nutrient absorption?

Decreased absorption of all nutrients Signup and view all the answers

Which bacteria is NOT typically associated with infections of the small intestine?

Clostridium botulinum Signup and view all the answers

Which diagnostic test is primarily used to confirm coeliac disease?

Small bowel biopsy Signup and view all the answers

What characterizes Whipple's disease in terms of causative agent?

A bacteria Signup and view all the answers

What is a significant histological feature of chronic inflammation in coeliac disease?

Lymphoplasmacytic infiltrate in the lamina propria Signup and view all the answers

Which condition is associated with acute appendicitis?

Obstruction of the appendiceal lumen Signup and view all the answers

Which form of diarrhea is NOT typically infectious in origin?

Diarrhea resulting from antibiotic treatment Signup and view all the answers

What histological feature distinguishes coeliac disease from normal duodenal mucosa?

Lymphocytes in the epithelium Signup and view all the answers

Which of the following is a long-term consequence of untreated coeliac disease?

Non-Hodgkin's lymphoma Signup and view all the answers

What is a common symptom of Giardiasis?

Mild abdominal discomfort leading to malabsorption Signup and view all the answers

Which characteristic is associated with Whipple's disease?

It can cause lipodystrophy Signup and view all the answers

What distinguishes the diagnosis of infectious enteritis caused by Giardiasis from coeliac disease?

Presence of trophozoites along the surface of epithelial cells Signup and view all the answers

In which condition would you expect to find eosinophils in the lamina propria of the small intestine?

Coeliac disease Signup and view all the answers

What is the primary dietary management strategy for coeliac disease?

Gluten-free diet Signup and view all the answers

Which of the following conditions is NOT commonly associated with coeliac disease?

Crohn's disease Signup and view all the answers

Which feature is characteristic of the histological findings in Whipple's disease?

Distension of macrophages containing PAS+ granules Signup and view all the answers

What is a primary cause of malabsorption syndromes?

Autoimmune disorders like coeliac disease Signup and view all the answers

What is the overriding predictor of aggressive behavior in neuroendocrine tumors?

Grade measured by mitotic count Signup and view all the answers

Which of the following is NOT a common symptom associated with hepatic metastases of carcinoid tumors?

Severe abdominal pain Signup and view all the answers

Which of the following is a common cause of appendiceal obstruction?

Gallstone Signup and view all the answers

What is the most common type of appendicitis?

Acute suppurative appendicitis Signup and view all the answers

Which dietary factors are most associated with an increased risk of acute appendicitis?

Low fiber, high protein Signup and view all the answers

What is the most common cause of small intestinal obstruction?

Hernia Signup and view all the answers

Which of the following conditions is NOT a cause of small intestinal obstruction?

Ileocecal valve syndrome Signup and view all the answers

What complication can occur due to a hernia in the peritoneal cavity?

Strangulation Signup and view all the answers

In adults, intussusception is often associated with?

Neoplasms Signup and view all the answers

What is the most frequent form of malignancy found in the small bowel?

Primary GI Lymphoma Signup and view all the answers

Which of the following benign tumors is associated with Peutz-Jeghers syndrome?

Hamartomatous polyps Signup and view all the answers

What is a potential cause of bowel obstruction due to associated twisting?

Volvulus Signup and view all the answers

Which malignant tumor is most likely to complicate existing inflammatory diseases like Crohn’s or Coeliac disease?

Adenocarcinoma Signup and view all the answers

What is the primary characteristic of gallstone ileus?

Presence of gallstones in the intestine Signup and view all the answers

Which of the following is a common presenting feature of small bowel obstruction?

Colicky abdominal pain Signup and view all the answers

What is intestinal atresia?

An abnormal development of the intestinal lumen leading to a string-like segment of bowel. Signup and view all the answers

Which of the following statements about Meckel's diverticulum is correct? (Select all that apply)

It is a congenital diverticulum located near the caecum. Signup and view all the answers

Which of the following are causes of non-infectious diarrhea? (Select all that apply)

Radiation enterocolitis Signup and view all the answers

Which of the following protozoa can infect the small intestine? (Select all that apply)

All of the above Signup and view all the answers

Which of the following bacteria are known to cause infections in the small intestine? (Select all that apply)

Vibrio Signup and view all the answers

Which of the following conditions are associated with Coeliac? (Select all that apply)

Non infectious Signup and view all the answers

Which of the following genetic risk factors are associated with Coeliac Disease?

HLA class II genesDQ2 & DQ8 Signup and view all the answers

What diagnostic tests are used for Coeliac Disease? (Select all that apply)

Small bowel biopsy Signup and view all the answers

TTG can be negative if

the patient is on a gluten-free diet Signup and view all the answers

Which of the following histological features are associated with coeliac disease? (Select all that apply)

Villous atrophy – Partial/Subtotal Signup and view all the answers

Which feature is characteristic of coeliac disease?

Presence of lymphoplasmacytic infiltrate in the lamina propria Signup and view all the answers

Which of the following statements about Coeliac Disease is correct?

Symptoms improve with a gluten-free diet. Signup and view all the answers

Which of the following extra-GI disorders are associated with Coeliac Disease? (Select all that apply)

Dermatitis Herpetiformis Signup and view all the answers

What are the characteristics of Dermatitis Herpetiformis?

Pruritic (itchy) skin rash with vesicles (small blisters), extensor surfaces Signup and view all the answers

Which of the following is a long-term complication associated with small bowel disorders? (Select all that apply)

All of the above Signup and view all the answers

What type of lymphoma is associated with long-term complications of coeliac disease?

Non-Hodgkin's enteropathy associated T-cell lymphoma (EATL) Signup and view all the answers

Which of the following are long-term complications of coeliac disease? (Select all that apply)

Stricture formation Signup and view all the answers

Which statement about giardiasis, caused by the intestinal protozoan Giardia, is true?

Giardiasis is primarily transmitted through contaminated water. Signup and view all the answers

Which disease histology can GIARDIASIS mimic?

Coeliac Disease Signup and view all the answers

Which of the following statements are true regarding Giardiasis? (Select all that apply)

Patchy villous abnormality Signup and view all the answers

What is Whipple's disease characterized by?

A rare systemic illness with a severe malabsorption syndrome Signup and view all the answers

What histological features are characteristic of Whipple's disease?

Infiltration of various organs by macrophages containing organisms Signup and view all the answers

Which of the following statements about Whipple's disease is correct?

It responds to antibiotic therapy Signup and view all the answers

Which of the following statements accurately describes Whipple's disease?

Distended macrophages in lamina propria containing Signup and view all the answers

What is a characteristic feature of macrophages in Whipple's disease?

Positive PAS (periodic acid-Schiff) stain Signup and view all the answers

Which of the following statements about Crohn's disease is true?

It primarily affects the small intestine. Signup and view all the answers

Which of the following are presenting features of bowel obstruction? (Select all that apply)

Colicky abdominal pain with distension Signup and view all the answers

Which of the following conditions can cause small intestinal obstruction? (Select all that apply)

Hernia Signup and view all the answers

What is a hernia in small intestinal obstruction?

A weakness in the wall of the peritoneal cavity allowing viscera to intrude Signup and view all the answers

What are adhesions in the context of healing peritonitis?

Fibrous bridges that can create closed loops trapping the intestines Signup and view all the answers

Which of the following is a common cause of intussusception in adults?

Intraluminal mass Signup and view all the answers

What is intussusception?

A condition where a proximal segment of bowel telescopes into the immediately distal segment. Signup and view all the answers

Intussusception can lead to .............. of the affected segment.

compromised vascular supply Signup and view all the answers

What is the term for the complete twisting of a loop of bowel about its mesenteric base?

Volvulus Signup and view all the answers

Which of the following are considered causes of volvulus? (Select all that apply)

Idiopathic Signup and view all the answers

Which of the following are secondary causes of volvulus? (Select all that apply)

Congenital malrotation Signup and view all the answers

Which of the following are examples of benign tumors in the small bowel? (Select all that apply)

Adenomas Signup and view all the answers

Do hamartomatous polyps occur due to Peutz-Jeghers syndrome?

Yes, they can occur due to Peutz-Jeghers syndrome. Signup and view all the answers

Leiomyomas are tumors which are composed mainly of what type of tissue?

Smooth muscle tissue Signup and view all the answers

What type of tissue do lipomas primarily consist of?

Adipose tissue Signup and view all the answers

Adenomas are tumors that contain what type of tissue?

Epithelial tissue Signup and view all the answers

Which of the following describes adenocarcinoma in the context of small bowel neoplasia?

A malignant tumor that arises from glandular tissue Signup and view all the answers

Which of the following conditions can lead to the complication of adenocarcinoma? (Select all that apply)

Crohn's disease Signup and view all the answers

Which of the following statements about adenocarcinoma of the small intestine is true?

Adenocarcinoma accounts for 2% of gastrointestinal tumors. Signup and view all the answers

What is the commonest form of malignancy of the small bowel?

Primary GI Lymphoma Signup and view all the answers

Which of the following statements is true regarding T-cell lymphoma and its relation to coeliac disease (EATL)?

T-cell lymphoma can occur as a complication of coeliac disease. Signup and view all the answers

Primary GI Lymphoma T cell often complicates coeliac disease (EATL) and is typically ______ positive.

CD3 Signup and view all the answers

What is the characteristic of GI lymphoma B cell arising from mucosa-associated lymphoid tissue (MALToma)?

CD20 positive Signup and view all the answers

GI lymphoma arising from the B cells is primarily associated with which of the following?

Mucosa-associated lymphoid tissue Signup and view all the answers

Which statement is true regarding neuroendocrine (carcinoid) tumors?

They arise from neuroendocrine cells throughout the gastrointestinal tract. Signup and view all the answers

What function do NEC cells serve in the gastrointestinal tract?

Secrete hormones Signup and view all the answers

What factors correlate with the malignant behavior of neuroendocrine tumors?

All of the above Signup and view all the answers

Which of the following best describes how neuroendocrine grade is determined?

A Ki-67 stain Signup and view all the answers

Which statement is true about neuroendocrine tumors?

They can be frequently asymptomatic. Signup and view all the answers

What do carcinoid tumors most commonly synthesize and secrete?

Serotonin Signup and view all the answers

What symptoms can result from hepatic metastases of carcinoid tumors in carcinoid syndrome? (Select all that apply)

Facial flushing Signup and view all the answers

Which statement about acute appendicitis is true?

It is the most common surgical emergency. Signup and view all the answers

What is the consequence of continued secretion of mucin in acute appendicitis?

Increased intraluminal pressure and ischemic injury Signup and view all the answers

Which of the following can cause appendiceal obstruction? (Select all that apply)

Faecolith Signup and view all the answers

Which of the following statements about non-obstructive appendicitis is true? (Select all that apply)

It can be secondary to generalized illness, usually viral like Measles. Signup and view all the answers

In the case of acute appendicitis, normal appendiceal glands are:

Almost completely destroyed Signup and view all the answers

Which of the following are complications of acute appendicitis? (Select all that apply)

Perforation with peritonitis Signup and view all the answers

Which of the following diseases can involve the appendix? (Select all that apply)

Ulcerative colitis Signup and view all the answers

Which of the following are types of tumors or tumor-like conditions of the appendix? (Select all that apply)

Neuroendocrine (Carcinoid) tumors Signup and view all the answers

Which of the following statements is true regarding duodenal ulcers?

Peptic ulcer disease can affect the duodenum. Signup and view all the answers

What causes gastric peptic ulcer disease (PUD) according to the provided information?

Altered mucosal defenses Signup and view all the answers

Which of the following statements accurately describe the characteristics of duodenal peptic ulcer disease (PUD)?

Increased acid production is a primary factor. Signup and view all the answers

Which of the following symptoms are associated with duodenal ulcers? (Select all that apply)

Waking at night with upper abdominal pain Signup and view all the answers

What is the primary treatment approach for the eradication of H. pylori in duodenal conditions?

Combination of acid suppressive therapies and antibiotics Signup and view all the answers

What is a typical feature of gross pathology in duodenal ulcers?

Usually a single lesion within 2 cm of pylorus. Signup and view all the answers

Multiple lesions throughout the duodenum suggest which of the following conditions?

Zollinger-Ellison syndrome Signup and view all the answers

Which of the following statements is true regarding duodenal ulcer characteristics?

The ulcer margins are well defined and may have a large vessel with an open lumen at the ulcer base. Signup and view all the answers

Study Notes

Small Bowel Disorders Overview

Small intestine functions: enzymatic digestion and absorption of nutrients and water.
Villi in the small bowel enhance surface area, measuring approximately 1mm in length.

Learning Outcomes

Understand normal small bowel structure and function.
Identify causes and consequences of small bowel dysfunction.
Recognize diarrhea and malabsorption causes.
Describe coeliac disease, Whipple's disease, giardiasis, and tumors of the small bowel and appendix.
Assess acute appendicitis causes, clinical presentation, and pathology.

Disease Categories

Categories include congenital anomalies, inflammatory, malabsorption syndromes, bowel obstruction, and neoplasia.

Congenital Anomalies

Meckel’s Diverticulum: Failure of vitello-intestinal duct involution; complications include perforation, hemorrhage, and obstruction.
Intestinal Atresia: Development failure leads to blocked intestinal lumen.
Stenosis: Narrowing of bowel lumen, can arise from developmental issues or intussusception.

Coeliac Disease

Immune reaction to gluten leading to atrophy of villi.
Symptoms: weight loss, abdominal pain, diarrhea, potentially severe malnutrition.
Associated disorders: dermatitis herpetiformis and various endocrine disorders.
Long-term risks include lymphoma, adenocarcinoma, ulceration, and malnutrition.
Diagnosis via small bowel biopsy and serological tests; treatment with gluten-free diet.

Infectious Enteritis

Giardiasis: Caused by intestinal protozoan; symptoms include abdominal discomfort to malabsorption; transmitted through contaminated water.
Whipple’s Disease: Rare systemic infection caused by Tropheryma whippelii; characterized by severe malabsorption and lipid accumulation in tissues; treated with antibiotics.

Other Malabsorption Syndromes

Crohn’s Disease: An inflammatory bowel condition leading to malabsorption.
Lactose Intolerance: Caused by lactase deficiency; symptoms include gastrointestinal upset after dairy consumption.

Infections of the Small Intestine

Viral (e.g., rotavirus, Norwalk).
Bacterial (e.g., Salmonella, Shigella, E.coli).
Protozoan (e.g., Giardia Lamblia, Cryptosporidium).
Worm infections (e.g., Strongyloides stercoralis) can cause severe diarrhea.

Non-Infectious Diarrhea

Conditions include radiation enterocolitis and inflammatory bowel diseases.

Bowel Obstruction

Commonly occurs in the small bowel; presents with colicky pain, distension, and constipation.
Causes: hernia, adhesions, intussusception, volvulus, neoplasms.

Neoplastic Conditions

Benign Tumors: Include adenomas, lipomas, and hamartomatous polyps.
Malignant Tumors:
- Adenocarcinoma: Rare (2% of GI tumors); arises primarily in the duodenum.
- Primary GI lymphoma: Most common malignancy of the small bowel, often associated with coeliac disease.
- Neuroendocrine (carcinoid) tumors, potentially leading to carcinoid syndrome characterized by flushing and diarrhea.

Acute Appendicitis

Most common surgical emergency, often linked to low-fiber diets leading to obstruction.
Symptoms include periumbilical pain shifting to the right iliac fossa, fever, and leukocytosis.
Complications can include perforation and peritonitis, with a historical mortality rate of up to 35%.

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Description

This quiz provides an overview of small bowel disorders, including their structure, function, and various diseases such as coeliac and Whipple's disease. You'll explore the causes of small bowel dysfunction, common symptoms like diarrhea, and the implications of conditions like acute appendicitis. Test your understanding of congenital anomalies and other related disorders.