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Path: Small Bowel Disease (i) (Inflamm (bacteria (Tropheryma whippelii…
Path: Small Bowel Disease (i)
Intro
6m long
duodenum, jejunum, ileum
layers: mucosa, submucosa, muscular propria (externa), submersa, serosa
microvilli increase absorptive surface (brush border)
ratio of villus:crypt length = 5:1
function
enzymatic digestion
absorption of nutrients + water
vast SA due to villi
Congenital anomalies
Meckel's diverticulum
failure of involution of vitello-intestinal (vitelline) duct (long narrow tube that joins yolk sac to midgut lumen of developing foetus)
complications
perforation
enteroumbilical fistula
peptic ulceration (usually in adjacent ileum + not in diverticulum)
haemorrhage (can be massive in children)
intussusception (1 segment of intestine "telescopes" inside of another causing an intestinal obstruction)
obstruction
intestinal atresia
failure of development of intestinal lumen (string-like segment of bowel)
tx = resect + join up 2 ends
stenosis
lumen narrowing
less common
developmental failure
risk of intussusception
Inflamm
can be infectious or idiopathic
bacteria
salmonella
campylobacter
shigella
E Coli
vibrio
yersinia
TB
Tropheryma whippelii (Whipple's disease)
systemic illness
severe malabsorption syndrome
in dDx of coeliac
rare
can affect any organ (GIT, joints, CNS)
infiltration of various organs by foamy macrophages containing the organisms (known as lipid pools)
lamina propria of SI
mesenteric lymph nodes
CNS
responds to antibiotics
dx = PAS stain
distended macrophages in lamina propria containing PAS +ve (diastase resistant) granules which are the organisms
viruses
rotavirus
norwalk
others
protozoa
giardia lamblia (giardiasis)
intestinal protozoan
in dDx of coeliac
patchy villous abnormality
trophozoites along surface of epithelial cells
faecal contamination of water (lakes, spas, pools) where there is poor sanitation + unsafe water
symptoms range from mild abdo discomfort to malabsorption
cryptosporidium
entamoeba
nematodes - strongyloides stercoralis
can lose 10-14 L/day if diarrhoea is severe
non-infectious diarrhoea
radiation enterocolitis (radiation affects absorptive function)
graft vs host disease
IBD
other diseases involving the appendix
UC
Crohn's
sarcoid
yersiniosis
tumour/tumour-like appendiceal conditions
carcinoid tumours
mucocoele (dilatation of appendix by mucinous secretion)
mucosal hyperplasia
mucinous cystadenoma/cystadenocarcinoma