Diseases of the Small Bowel

Question 1

What are the tumors of the appendix? Just list them

Answer 1

• Carcinoid **most common **
• Benign (mucinous cystadenoma, villious adenoma)
• Malignant (adenocarcinoma, lymphoma)
• Secondary tumors (aka metastasis)

Overall rare —

Question 2

Name 4 types of diarrhea based on stool characteristics. Give examples of each

Answer 2

Fatty

• Malabsorption
• Maldigestion

Watery

• Osmotic (lactose intolerance, carb malabsorption)
• Secretory (bacteria, neuroendo tumors, bile salt malabsorption)

Inflammatory/Exudative

• Infection
• IBD (Crohn’s, UC)
• Ischemia

Functional

Question 3

Describe the clinical presentation of fat malabsorption

Answer 3

Depends on the vitamin deficiency

Vit A: night blindness, xerophthalmia

D: Osteomalacia

E: Rare in adults, hemolytic anemia

K: clotting dysfunction (look at PT)

Question 4

Describe the causes of fat malabsorption

Answer 4

• Mucosal diseases (Celiac, Whipple’s)
• Short bowel syndrome
• Smal bowel bacterial overgrowth

Question 5

Describe the pathogenesis of celiac disease

Answer 5

Gluten-sensitive enteropathy (wheat, barley, rye)

• Associated w/ autoimmune diseases (F:M = 2:1)
• HLA-DQ2, HLA-DQ8 (40% in the US)
• CD4+ T cell response (IELs)
• All have antibodies to tissue transglutaminase

Question 6

Describe the diagnosis of celiac disease

Answer 6

• Findings on small intestine biopsy

- Serology: anti-tissue transglutaminases

Question 7

Describe the treatment of celiac disease

Answer 7

Gluten free diet

- corn, rice, soy, millet

Question 8

Describe the pathogenesis of small bowel bacterial overgrowth

Answer 8

Normal bacteria

Question 9

Describe the diagnosis of small bowel bacterial overgrowth

Answer 9

• Aspirate duodenum w/ culture
• Glucose-hydrogen breath test
• Empiric tx w/ antibiotics

Question 10

Describe the treatment of small bowel bacterial overgrowth

Answer 10

Antibiotics

e.g. Ciprofloxacin