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Year 1: Gastrointestinal > GI: Conditions of the small intestine > Flashcards

GI: Conditions of the small intestine Flashcards

1
Q

What is the role of the small intestine?

A

To digest and absorb nutrients

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2
Q

What are the symptoms of small bowel disease?

A 
Diarrhoea 
Steatorrhoea 
Abdominal pain/distension 
Anorexia
Weight loss
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3
Q

What are the most common disorders of the small intestine that cause malabsorption?

A

Coeliac’s disease

Crohn’s disease

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4
Q

What investigations are indicated in a patient with small bowel disease symptoms and/or folate deficiency/vitamin B12 deficiency?

A

First line: Coeliac serology (tTG antibodies)
Small bowel barium follow through
Endoscopic small bowel biopsy

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5
Q

What is coeliac disease?

A

An autoimmune sensitivity to gluten

Associated with HLA DQ2 in 95% of people

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6
Q

What is the toxic portion of the gluten molecule?

A

Alpha-gliadin

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7
Q

What histological findings are characteristic of coeliac disease?

A

Abnormal jejunal mucosa
Villous atrophy
Crypt hyperplasia

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8
Q

What two age groups does coeliac disease present in?

A

Infancy

Adults in their 50s

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9
Q

What signs + symptoms might a patient with coeliac disease present with?

A

Small bowel disease symptoms (typically diarrhoea and weight loss)
or
Symptoms may be non specific (malaise/fatigue)

Physical signs related to anaemia/malnutrition: angular cheillitis + apthous ulcers

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10
Q

Which patients should be offered coeliac serology testing?

A 
Patients with:
A first degree relative affected by the disease
Type 1 diabetes
Thyroid disease 
Autoimmune liver disease
Down's syndrome 
IBS
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11
Q

What is the first-line investigation for coeliac disease?

A

Serology: anti-tTG antibodies

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12
Q

How is coeliac disease diagnosed?

A

Duodenal biopsy

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13
Q

What other investigation is performed at the diagnosis of coeliac disease?

A

Bone densitometry due to increased risk of osteoporosis

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14
Q

Which vaccine is given in coeliac disease?

A

Pneumococcal vaccine due to association of hyposplenism (reduced spleen function)

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15
Q

What is dermatitis herpetiformis?

A

An itchy, symmetrical rash that indicates underlying coeliac disease

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16
Q

How is dermatitis herpetifromis diagnosed?

A

Skin biopsy + serology for ETG antibodies

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17
Q

How is dermatitis herpetiformis treated?

A

Dapsone (antibiotic) + gluten free diet

18
Q

What is whipple’s disease?

A

A rare, bacterial infection of the small bowel

19
Q

What are the symptoms of whipple’s disease?

A 
Steatorrhoea
Abdominal pain 
fever
arthritis 
Lymphadenopathy
20
Q

What sign is seen on biopsy for Whipple’s disease?

A

Acid Schiff positive macrophages

21
Q

How is whipple’s disease treated?

A

Co-trimoxazole for 1 year

22
Q

Reactivation of primary TB can affect which part of the GI tract?

A

Ileocaecal valve

23
Q

What are the common causes of mesenteric ishaemia?

A

Atherosclerosis

Thromboembolism

24
Q

What is the main symptom of mesenteric ishaemia?

A

Cramping abdominal pain

25
Q

How is mesenteric ishaemia diagnosed?

A

Angiography

26
Q

How is mesenteric ishaemia treated?

A

Urgent surgery

27
Q

How do tumours of the small intestine present?

A

Abdominal pain
Diarrhoea
anorexia
weight loss

28
Q

Are primary or secondary tumours of the small bowel more common?

A

Secondary- primary tumours are rare

29
Q

What is the most common malignant tumour of the small bowel?

A

Adenocarcinoma

30
Q

What cells does a lymphoma arise from?

A

T and B cells

Increased incidence in coeliac and crohn’s patients

31
Q

What cells does a carcinoid tumour arise from?

A

Enterocromaffin cells

32
Q

What is gallstone ileus?

A

When a large gallstone migrates via fistulas into the small intestine and becomes lodged

33
Q

What is the name of the most common fistula between the gall bladder and small intestine?

A

Cholecystoduodenal fistula

34
Q

What are the symptoms of small bowel obstruction?

A 
Colicky abdominal pain
Absolute constipation (no passing of gas) 
Abdominal distension 
Faeculent vomiting
35
Q

What is the buzz word for small bowel obstruction?

A

Tinkling bowel sounds

36
Q

What can cause small bowel obstruction?

A

Adhesions from previous surgery
Crohn’s disease (narrowing due to inflammation + scarring)
Tumours
Hernias

37
Q

What investigations are done in suspected bowel obstruction?

A

AXR
Contrast Abdo CT
FBC
Urine analysis

38
Q

How is small bowel obstruction managed?

A

‘Drip and Suck’ - NG tube drain + IV fluids and potassium

39
Q

Is surgery indicated in small bowel obstruction?

A

Most cases settle without surgical intervention

ONLY indicated if there is risk of strangulation, perforation or ischaemia

40
Q

Which histological part of the bowel is most sensitive to hypoxia?

A

The mucosa as it is most metabolically active

Year 1: Gastrointestinal (14 decks)

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