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Gastrointestinal* > Diseases of the Small Intestine > Flashcards

Diseases of the Small Intestine Flashcards

1
Q

What is coeliac disease?

A

Autoimmune inflammation of small bowel mucosa in response to gluten proteins

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2
Q

What genes is coeliac disease associated with?

A

HLA DQ2 and HLA DQ8

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3
Q

What happens histologically in coeliac disease?

A

villi become flattened, reducing capacity for absorption

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4
Q

Symptoms of coeliac disease

A

asymptomatic, diarrhoea, steatorrhoea, abdo pain, mouth ulcers, angular stomatitis, weight loss, anxiety and depression

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5
Q

Investigations into coeliac

A 
Bloods: tTGA IgA, EMA
THEN FOR DIAGNOSIS MUST DO:
Small bowel biopsy - villous atrophy 
Histology - subtotal villous atrophy, crypt hyperplasia + increased lymphocytes 
DEXA bone scan to assess osteoporosis
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6
Q

Treatment of coeliac

A

Mineral and vitamin replacement (compensate of malabsorption)
Gluten-free diet for life - with help of trained dietician

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7
Q

Complications of coeliac

A

Osteoporosis

Enteropathy-assoicated T-cell lymphoma

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8
Q

What is the definition of intestinal failure?

A

Body’s nutritional needs are no longer met by gut due to malabsorption

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9
Q

What is acute IF?

A

Less than 2 weeks i.e. post-chemo

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10
Q

What is chronic IF?

A

Small bowel syndrome

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11
Q

What length of small bowel is classified as small bowel syndrome?

A

< 200 cm (normal 250-850cm)

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12
Q

Type I IF definition

A

Self-limiting, short term, usually post-op

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13
Q

Type I IF feeding

A

Paraenteral nutrition

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14
Q

Type II IF definition

A

Prolonged, sepsis + metabolic compensation, usually complication of abdo surgery

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15
Q

Type II IF feeding

A

Paraenteral +/- enteral nutrition

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16
Q

Type III IF definition

A

Long-term but stable

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17
Q

Type III IF feeding

A

Home parental nutrition

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18
Q

What is total parenteral nutrition (TPN)?

A

When no significant nutrition is obtained from other routes

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19
Q

Complications of parenteral nutrition

A

Misplacement - pneumothorax, atrial puncture
Sepsis
Line fracture/leakage/migration
SVC obstruction

20
Q

Types of enteral nutrition

A

NG, NJ, percutaneous endoscopic gastrostomy/jejunostomy

21
Q

Where is peripheral nutrition entered into body?

A

Central/peripheral vein

22
Q

Symptoms of intestinal obstruction

A

Vomiting, abdo pain, abdo distension and constipation

23
Q

Causes of bowel obstruction

A

Luminal obstruction, bowel wall obstruction, mesenteric arterial occlusion, strangulation obstructing venous return

24
Q

Luminal obstruction examples

A

Gallstone ileum, food, bezoar

25
Q

Bowel wall obstruction examples

A

Tumours, Crohn’s. enteritis

26
Q

Mesenteric arterial occlusion examples

A

Atherosclerosis, thromboembolism from the heart

27
Q

Strangulation obstruction venous return examples

A

Hernia, adhesion

28
Q

Causes of intestinal failure

A

Extensive surgery, obstruction, malabsorption, congenital defects

29
Q

What is small bowel syndrome?

A

When small bowel >50 cm

30
Q

Investigation of small bowel syndrome

A

FBC, urinalysis, ABGs
AXR, contrast CT abdo
Enema XR if necessary

31
Q

Symptoms of bowel obstruction?

A

Severe colicky pain, abdo distention and tenderness, decreased/absent bowel sounds, faeculent bowel sounds, constipation

32
Q

Treatment of bowel obstruction

A
  1. HPN
  2. Analgesia, fluids, K+ replacement
  3. Anti-embolism measures
  4. NG tube draining
  5. Surgery if perforation/strangulation/ischaemia
    - early laparotomy
    - small bowel transplantation
    Antibiotics
33
Q

Antibiotics taken for small bowel syndrome

A

Metronidazole + gentamicin

34
Q

What is Meckel’s Diverticulum a remnant of?

A

The vitello-intestinal duct

35
Q

Symptoms of Meckel’s Diverticulum

A

Asympt, painless malaenia, can mimic appendicitis –> bleeding, perforation, diverticulitis

36
Q

Investigations of Meckel’s Diverticulum

A

Technicium Tc 99M scan - detects ectopic gastric mucosa

37
Q

Treatment of Meckel’s Diverticulum

A

Laparoscopic surgical resection

38
Q

What and where is Meckel’s Diverticulum?

A

Tubercular structure 60cm (ish) from ileocaecal valve

39
Q

Types of primary small bowel tumours

A

Lymphomas, carcinoids and adenocarcinomas

40
Q

Lymphoma of the small bowel

A

Maltomas, enteropathy-associated T-cell (coeliac)

41
Q

Lymphoma treatment

A

Surgery and chemo

42
Q

Carcinoid of small bowel

A

Small, yellow, slow-growing, locally-invasive, obstructive, found in appendix

43
Q

If carcinoid tumour of appendix metastasis to liver

A

Carcinoid syndrome

44
Q

What is the presentation of carcinoid syndrome?

A

Flushing, diarrhoea

45
Q

Treatment of carcinoid of tip of appendix?

A

Appendectomy

46
Q

Treatment of carcinoid base of appendix

A

Right hemicoloectomy

Gastrointestinal* (15 decks)

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