Diseases Of The Small Bowel

Question 1

Small bowel common symptoms

Answer 1

Diarrhea (post prandial, nocturnal, malabsorption, weight loss)
Abdominal pain (periumbilical)
Obstruction (pain, feculent vomiuts)
Bleeding

Question 2

Causes of toxin mediated diarrhea

Answer 2

S aureus, v cholera, ETEC, EHEC, C. Perfingens, B . Cerrus

Question 3

Causes of maldigestive diarrhea

Answer 3

Pancreatitis not producing enzymes
Post bilroth
Lack of stomach acid or intrinsic factor

Question 4

Causes of malabsorption diarrhea

Answer 4

Lactose intolerance

Question 5

Cause of steatorrhea

Answer 5

Pancreatic insufficiency, bile salt deficiency, impaired absorption all around (Short gut
Bacterial overgrowth)

Question 6

Dietary factors that can cause diarrhea

Answer 6

Sugar free candy, high fructose corn syrup, lactose

Question 7

Causes of osmotic diarrhea

Answer 7

Medications: Mg supplements, osmotic laxative abuse

Carbohydrate malabsorption: lactose, high fructose corn syrup, sugar alcohols

Question 8

Causes of inflammatory diarrhea

Answer 8

IBD
Celiac
Infection
 Ischemia
Radiation side effect
Lymphoma

Question 9

Lab tests for fat in stool

Answer 9

Fecal fat/ fecal elastase

Low elastase means it could be pancreatitis

Question 10

Lab test for fecal WBCs

Answer 10

Fecal calprotectin or lactoferrin

Question 11

Lab tests for fat soluble vitamins

Answer 11

Carotene- A
Vitamin D panel- D
PT/INR- K

No test for E

Question 12

Why would we test albumin or total protein?

Answer 12

Make sure youre not losing it in stool

Question 13

low B12 means what part of intestine is not working?

Answer 13

Ileum

Question 14

If ferritin is over ________, then it is likely to be iron deficiency anemia.

Answer 14

100

Question 15

RBC folic acid is better because it tells you what?

Answer 15

Tells you about the long term folate absorption

Question 16

Serum TTG tests what?

Answer 16

Celiac

Question 17

Radiology studies for small intestine

Answer 17

Small bowel series
Enteroclysis- NG tube contrast
CT enterography- special contrast for distension wall vs. lumen

Question 18

Endoscopic imaging of the small bowel

Answer 18

Push enteroscopy- passes ligament of treitz, up to proximal jejunum

Capsule endoscopy- swallow it and walk around

Double balloon enteroscopy- mouth to anus creep along

Spirus enteroscopy- screws along

Question 19

Congenital malformations of small bowel

Answer 19

Meckels diverticulum

Malrotation of intestinal sides

Question 20

What is meckels diverticulum?

Answer 20

Congenital anomaly of the small intestine,
Incomplete obliteration of the vitteline duct leading to diverticulum in distal ileum
May need to be removed

Question 21

What is angioectasia?

Answer 21

Dilated vessel in the SI that may bleed
Bleeding vessel needs to be cauterized

Bad case= hereditary hemorrhagic telangiectasia

Question 22

Management of short gut

Answer 22

Continuous enteral feeding
Elemental feeds for easy absorption and less fluid loss
Complex feeds for adaption

Question 23

What does loss of ileocecal valve lead to?

Answer 23

Loss of mechanical slowing

Loss of ileal breaks when you eat a fatty meal

Question 24

Where do angioectasias localize?

Answer 24

Proximally in the small bowel

Question 25

Autoimmune diseases of the small bowel

Answer 25

``` Celiac disease Crohns Autoimmune enteritis Eosinophilic gastroenteritisi GVHD Vasculitis ```

Question 26

Celiac MHA affected

Answer 26

HLA-DQ2 or HLA DQ8 immune disorder

Question 27

Celiac disease is triggered by what component of gluten from wheat?

Answer 27

Gliadin TTG cross links glutamine rich proteins like gluten

Question 28

How do you make the diagnosis of celiac?

Answer 28

While on a gluten diet, test IgA anti-TTG or do a mucosal biopsy

Question 29

Diseases associated with celiac disease

Answer 29

Dermatitis herpetiformis, IgA deficiency, liver disease, down syndrome, AI thyroid disease, DM1, infertility, atrophic glossitis, cardiomyopathy, pancreatitis

Question 30

Celiac disease puts a patient at an increased risk of

Answer 30

Small bowel lymphoma and small bowel adenocarcinoma

Question 31

Common presentation of celiac disease

Answer 31

``` Diarrhea Steatorrhea Weight loss Malabsorption Iron deficiency Bloating Vinous atrophy ``` Resolves with gluten free

Question 32

Villous atrophy of celiac disease means

Answer 32

Poor absorption

Question 33

Guy with drainage from his left flank every time he eats

Answer 33

Crohn's enteric skin fistula Jejunum drains out of back

Question 34

Crohn's presentation

Answer 34

``` Abdominal pain Diarrhea Fistulae Obstruction Peri-anal disease Malabsorption Weight loss ```

Question 35

What kind of inflammation is seen in crohn's? What do they lead to?

Answer 35

Transmural inflammation leading to fibrosis, miroperforations and fistulae

Question 36

Extra-intestinal manifestations of crohns

Answer 36

Eye, erythema nodosum, pyoderma gangrenosum, arthritis, PSC, thromboemboli

Question 37

Celiac disease spares what?

Answer 37

The ileum, so B12 should be normal

Question 38

In what situation would there be an elevated serum folic acid but low normal serum b12?

Answer 38

Bacteria They produce folic acid and compete with B12

Question 39

When does D-xylose breath test peak?

Answer 39

When food is in colon not in duodenum

Question 40

Jejunal aspirate is the gold standard for what?

Answer 40

Small bowel bacterial overgrowth

Question 41

Lady with multiple hemartomatous polyps

Answer 41

Peutz-Jegher Syndrome

Question 42

Diarrhea differential types

Answer 42

Osmotic most common Inflammatory Secretory Fat malabsorption