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Gwen - GI and General surgery > Gen Surg: Small intestine disease and malabsorption (not including coeliac disease) > Flashcards

Gen Surg: Small intestine disease and malabsorption (not including coeliac disease) Flashcards

1
Q

What are symptoms of GI malabsorption?

A
  • Diarrhoea
  • Weight loss
  • Lethargy
  • Steatorrhoea
  • Bloating
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2
Q

What signs are common in GI malabsorption disorders?

A

Signs of deficiencies

  • Anaemia
  • Bleeding disorders
  • Oedema - protein deficeincy
  • Pathological fractures
  • Neurological features - neuropathy
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3
Q

What are disorders of the small intestine which can cause malabsorption?

A
  • Coeliac disease/dematitis herpatiformis
  • Tropical sprue
  • BActerial overgrowth
  • Intestinal resection
  • Whipple’s Disease
  • Radiation enteropathy
  • Parasitic infestation
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4
Q

What investigaitons would you consider doing in someone who was displaying features of GI malabsorption?

A
  • Bloods - FBC, Ca2+, Iron Studies, B12 + folate, INR, Lipid profile, Coeliac screen
  • Imaging - Endoscopy + SB biopsy
  • Other - Stool culture, Hydrogen breath test
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5
Q

What is tropical sprue?

A

A condition presenting with chronic diarrhoea and malabsorption that occurs in residents or visitors to affected tropical areas.

The term is reserved for severe malabsorption (2 or more substances) accompanied by diarrhoea and malnutrition

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6
Q

What is the cause of tropical sprue?

A

Unknown aetiology - likely to be infective

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7
Q

What is the pathology of tropical sprue

A

Malabsorption of fat and vit B12, vilous atrophy, inflammation

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8
Q

Presentation of someone with tropical sprie

A
  • Changes in bowel habit
    • Steatorhoea,
    • Diarrhoea
    • Bloating
    • Foul smelling/greasy stools
  • Fever
  • Leg swelling - hypoproteinaemia
  • Hair loss
  • Anaemia - pallor, angular stomatitis
  • Glositis in vit B12 deficiency
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9
Q

Investigations tropical spurae

A
  • Blood tests
    • FBC:
      • Folate deficiency
      • B12 deficiency
      • Megaloblastic anaemia
    • Iron, folate, B12 (all absorbed at small intestina)
  • D-xylose test (+ve in 94-100%)
  • Might consider O+P to rule out parasitice cause
  • Stool culture - bacterial cause
  • Imaging
    • ​DISTAL DUODENAL ENDOSCOPY AND BIOPSY
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10
Q

How would you manage someone with tropical sprue?

A
  • Remove from spure area
  • Consider Folic acid/B12
  • Consider Abx (tetracycline)
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11
Q

How would you approach investigating someone with suspected tropical sprue?

A

Investigations as for malabsorption (bloods, endoscopy etc.) - exclude infectious causes of diarrhoea

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12
Q

What is bacterial overgrowth?

A

A disorder of excessive bacterial growth in the small intestine. Unlike the colon (or large bowel), which is rich with bacteria, the small bowel usually has fewer than 10,000 organisms per millilitre

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13
Q

What are the main features of bacterial overgrowth?

A
  • Diarrhoea/steatorrhoea
  • Features of B12 deficiency
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14
Q

What investigation is used to confirm bacterial overgrowth?

A

Hydrogen breath test

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15
Q

What is involved in the hydrogen breath test?

A
  1. Mouth rinsed out with an antiseptic mouthwash beforehand.
  2. Take samples of end-expired air before giving lactulose
  3. Appearance of a breath hydrogen peak after oral lactulose is used to estimate mouth to caecum transit time
  4. An earlier rise in the breath hydrogen after lactulose indicates bacterial breakdown in the small intestine.
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16
Q

What result on hydrogen breath test indicates bacterial overgrowth?

A

Early increase in exhaled hydrogen = overgrowth

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17
Q

How would you manage someone wit bacterial overgrowth?

A
  • Treat cause - e.g. resect stricture
  • Consider rotatiing course of Abx
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18
Q

What can happen if too much small bowel is resected?

A

Small bowel syndrome

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19
Q

What nutrient abnormalities occur in ileal resection?

A

B12

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20
Q

What problems can occur in ileal resection?

A
  • Bile-salt induced diarrhoea
  • Steatorrhoea
  • Gallstone
  • Urinary stones formation
  • B12 deficiency
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21
Q

What is short-bowel syndrome?

A

Intestinal failure resulting from obstruction, dysmotility, surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance

22
Q

What is the major problem that can occur if small bowel is resected and a terminal small bowel stoma is put in place?

A

Sodium and fluid depletion - majority of patients with ≤100 cm of jejunum remaining will require parenteral supplements of fluid and electrolytes, often with nutrients.

23
Q

What do those with shortened small intestine with terminal small bowel stoma need to manage sodium and fluid losses?

A
  • Increased salt intake
  • Restriction of hypotonic fluids between meals
  • Oral glucose-electrolyte mixture
24
Q

What is Whipple’s Disease?

A

A rare infection caused by trophyeryma whipplei

25
Q

What organism is implicated in Whipples disease?

A

Tropheryma Whipplei

26
Q

Who is most at risk of whipples disease?

A

Farmers, spoils, animals

Male >50

27
Q

How can those with Whipples disease present?

A

Starts insidiously

  • Arthralgia - chronic, migratory, seroneagative
  • Colicky abdominal pain
  • Weight loss
  • Diarrhoea/Steatorrhoea
  • Chronic cough
  • Fever/sweats
  • Lymphadenopathy
  • Abdo pain
  • Other organs involved
    • Skin hyperpigmentation
    • Neurological features - reversible dementia, opthalmoplegia, facial myoclonus
    • Joints
    • Heart
28
Q

What neuological features can present in whipples disease?

A
  • Reversible dementia
  • Opthalmoplegia
  • Facial myoclonus
  • Hypothalamic syndrome - hyperphagia, polydipsia, insomnia
29
Q

What are systemic features of whipples disease?

A
  • Fever
  • Arthralgia
  • Chornic cough
  • Sweats
  • Lymphadenopathy
  • Skin hyperpigmentation
30
Q

What investigations would you perform if you suspected whipples disease?

A
  • Tests for malabsorption
  • Jejunal biopsy - Stunted villi + macrophage deposition in lamina propria + positive periodic acid-Schiff stain
31
Q

What can be present in whipples disease on biopsy?

A
  • Positive Periodic acid-Schiff stain macrophages
  • Trilaminar cell wall of T. Whipplei
32
Q

What might you use to confirm whipples disease following biopsy?

A

PCR of bacterial RNA

33
Q

How would you manage whipples disease?

A

ABx which crosses BB barrier

  • IV ceftriaxone - 2 weeks
  • Oral co-trimoxazole - 1 year
  • Doxycycline if neuro involvment
34
Q

What is giardiasis?

A

Small intestinal disease which is caused by giardia lamblia

35
Q

How is giardiasis spread?

A

Faecal-oral spread - water food/fomites

36
Q

How does giardiasis present?

A

Asymptomatic in most, but can have:

  • Diarrhoea
  • Flatulence
  • Bloating
  • Pain
  • Malabsorption
37
Q

How long does it take for symptoms to develop in giardiasis?

A

1-3 weeks

38
Q

How long does it take to symptoms to pass in giardiasis?

A

2-6 weeks

39
Q

How would you diagnose giardiasis?

A
  • Stool microscopy - cysts and trophozoites
  • Faecal immunoassay
  • PCR
  • Duodenal aspirate - from biopsy
40
Q

Would a negative stool sample in someone with suspected giardiasis exclude it as a diagnosis?

A

No - Intermittent shedding means it is excreted at irregular intervals

41
Q

How would you manage someone wtih giardiasis?

A
  • Improve hygeine
  • Oral Metranidazole - 2g dose three days in a row
42
Q

What can occur as a result of giardia infestation?

A

Lactose-intolerance

43
Q

What is regarded as the gold standard for confirmation of bacterial overgrowth?

A

Culture of small intestinal fluid

44
Q

What must you advise someone getting a hydrogen breath test to stop doing before the test is done?

A

Smoking

45
Q

What is meckel’s diverticulum?

A

A PAEDIATRIC condtion.

Presence of a segement of the vitello-intestinal duct. True congenital diverticulum (all 3 layers of intestinal wall).

46
Q

What is the “rule of 2s” in association with meckel’s diverticulum

A

Affects 2% of the population

2 feet proximal to illeocaecal valve

2% symptomatic

2 inches long

47
Q

Presentation of meckel’s

A

Typically asymptomatic and a finding at laparotomy

May present with rectal bleeding, ulceration, haemorrhage, short bowel obstruction ,diveticulutis, intussespection, volvulus, perforation

48
Q

Investigations meckel’s

A

Barium follow through, laparoscopy, technetium nuclear medicine (positive in 70%)

49
Q

Management of meckles

A

Resection of diverticulum

50
Q
A

Gwen - GI and General surgery (44 decks)

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