Path 2 Intestines

Question 1

Obstruction bowel sounds

Answer 1

Increased, high pitched

Question 2

Hernia

Answer 2

Protrusion of peritoneum into abdominal defect

Question 3

Intussusception

Answer 3

Telescoping of distal section into proximal section

Question 4

Volvulus

Answer 4

• Twisting of bowel loop around mesenteric base

- Commonly sigmoid

Question 5

Atresia

Answer 5

• Complete obsturction

- Commonly duodenum

Question 6

Stenosis

Answer 6

• Incomplete obstruction

- Commonly pylorus

Question 7

Meckels Diverticulum

Answer 7

• True diverticulum (all 4 layers of bowel)
• Persistent segment of vitelline duct (yolk sack -> gut lumen)
• 2 rule (2 inches long, 2% of pop, 2 feet from ileocecal valve)

Question 8

Hirschsprung disease

Answer 8

• Abnormal neural crest cell migration (Rectum +)
• Absence of ganglion cells for auerback & meissners plexus -> tonic contraction
• RET receptor kinase mutation (Down’s syndrome)

Question 9

Hirschsprung Dx

Answer 9

Biopsy

Question 10

Ischemic bowel disease

Answer 10

Any vascular obstruction

Question 11

Ischemic bowel watershed zones

Answer 11

• Splenic flexure

- Rectosigmoid colon

Question 12

IBS - Hypoperfusion v. obstruction

Answer 12

Mural v. Transmural

Question 13

Angiodysplasia

Answer 13

• Malformed blood vessels in cecum & right colon

- Presents around 60 y/o

Question 14

Dysentery

Answer 14

Painful bloody diarrhea

Question 15

Diarrhea with blood/pus

Answer 15

Exudative

Question 16

Diarrhea with steatorrhea

Answer 16

Malabsorption

Question 17

Diarrhea with hyperosmolarity

Answer 17

Osmotic and Malabsorption

Question 18

Diarrhea which persists on fasting

Answer 18

Secretory and Exudative

Question 19

Celiac Sprue

Answer 19

• Malabsorption diarrhea (villous atrophy)
• IgA to transglutaminase from Gluten
• Antiendomysial antibodies
• Dermatitis herpetiformis (IgA) 10%

Question 20

Abetalipoproteinemia

Answer 20

• Deficiency of Apo B-48, Apo B-100
• Defective LDL, VLDL, Chylomicron formation
• Acanthocytic RBCs (Burr cells)
• Enterocyte TG accumulation, lipid vacuoles

Question 21

Lactase deficiency

Answer 21

Disaccharidase deficiency

Question 22

Whipple disease

Answer 22

• Cuased by Tropheryma Whippelii actinomyces
• White males, 30-50y/o
• Distended macrophages in lamina propria with PAS granules
• Affects joints, CNS, intestines

Question 23

Cystic Fibrosis

Answer 23

• Meconium ileus (failure to pass)
• Defects in Cl- secretion from intestine & pancreas
• Absence of CFTR (Cystic Fibrosis Transmembrane conductance Regulator)

Question 24

Collagenous Enterocolitis

Answer 24

• Middle aged & older women

- Collagen band deposits under surface epithelium

Question 25

Lymphocytic Enterocolitis

Answer 25

Associated with autoimmune disease

Question 26

Enterocolitis presentation

Answer 26

- Chronic watery diarrhea - Benign - Normal endoscopy