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SMALL BOWEL (OBSTRUCTIONS (SBO)
'SHAVING' (STRICUTRES
IBD,…
SMALL BOWEL
-
ANATOMICAL
CONGENITAL
DUODENAL ATRESIA
- Congenital
- Assoc c Down Syndrome
- 'Double Bubble' Sign
- Ballooning on either side of pyloric sphincter seen on XR
MECKEL'S DIVERTICULUM
- Outpouching of All 3 Layers of Bowel Wall
- Results From Failure of Vitelline Duct to Involute
- Vitelline Duct connects Yolk Sac for Nutrients during early development
RULE OF 2s
- Most Common Congenital GIT Anomaly (2%)
- 2 Inches Long
- First 2 Years of Life
- 2 Inches from ileocaecal valve
ACQUIRED
VOLVULUS
- Twisting of Bowel Along its Mesentery
- Results in Obstrx & Disruptn of bld supply (Infarction)
- Commonly Sigmoid Colon (Elderly) & Cecum (Young Adults)
INTUSSUSCEPTION
- Telescoping of Bowel (in direction of peristalsis)
- Prox. Segment of Bowel into Dist. Segment
- Common Site: Ileocecal Jx
- Assoc. c Leading Edge
- Infarction
INFECTIVE
WHIPPLE DISEASE
- Systemic Tissue Damage
- TROPHERYMA WHIPPELII LADEN Mφ
- VISIBLE ON ELECTRON MICROSCOPY (EM)
- DIARRHEA = MALABSORBTIVE
- Lamina Propria
- Decr. Fat Abosrption
- Steatorrhea
-
METABOLIC
LACTOSE INTOLERANCE
- Decr. in Lactase in Enterocytes @ Brush Border
- DIARRHEA (NON-INFLAMMATORY)
CELIAC DISEASE
- FLATTENED DUODENAL VILLI
- IMMUNE MEDIATED DAMAGE
- RESPONSE TO WHEAT PROTEINS
- DIARRHEA
- INVESTIGATIONS:
- Mx
- GLUTEN FREE DIET/LIFESTYLE
NEOPLASTIC
CARCINOID TUMOUR
Low Grade Malignant Proliferation
PENTZ- JEGHERS
- AUTOSOMAL DOMINANT
- HAMARTOMATOUS GI POLYPS
- CAN BECOME MALIGNANT
- CAN CAUSE INTERSSUSSEPTION
- CLINICAL SIGN:
- DISCRETE BLACK/BROWN LIP LESIONS
VASCULAR
SM. BOWEL INFARCTION
CAUSES
VASCULITIS
- POLYARTERITIS NODOSA
- GRANULOMATOSIS WITH POLYANGIITIS
- HENOCH-SCHONLEIN
ATHEROSCLEROSIS
- WATERSHED INFARCTS = MOST DISTAL REGION AFFECTED
- DUE TO DECREASED LUMEN, THUS DECREASED PERFUSION
VESSEL WALL
- ABDOMINAL AORTIC ANEURYSM