GI: small bowel Flashcards
What percentage of nutrients does the small bowel absorb from the diet?
90%
What key vitamin does the large bowel (colon) absorb?
Magnesium
What is the definiton of coeliac disease?
an immune-mediated small intestinal enteropathy that is triggered by exposure to dietary gluten in genetically predisposed people
What physiological state does coeliac disease lead to that can make nutrient absorption poor?
villous atrophy- most commonly in proximal small bowel
What genes are coeliac disease associated with?
HLA genes DQ2 and DQ8
What are the symptoms of coeliac disease?
diarrhoea, bloating, abdominal pain, weight loss, fatigue, rash, sometimes no symptoms
Why do you get anaemia with coeliac?
Iron deficiency anaemia due to malabsorption
How do you diagnose coeliac disease?
Transglutaminase antibody, EMA- have to be still eating gluten to test positive. Duodenal biopsy sometimes required
Why might someone test negative for TTG/EMA if they have coeliac disease?
If patient is IgA deficient (1 in 300)
How effective is GF diet in coeliac disease?
99%
What are the treatments for coeliac disease?
Gluten free diet
Vitamin supplementation- calcium and vitamin D
Vaccination against pneumococcus
What are the complications of coeliac disease?
-Osteopenia/osteoporosis
-Refractory coeliac disease- continued small bowel damage despite (apparently) removing gluten from diet- could be gluten exposure or immune mediated requiring steriods and immunosuppression
-T-cell lymphoma
What type of fibre should some people avoid when they have IBS?
insoluble fibre
What is small intestine bacterial overgrowth?
The presence of excessive bacteria in the small intestine. Can present a bit like irritible bowel syndrome.
How do you test for SIBO?
Lactulose hydrogen breath test, duodenal aspirate and culture
What is the treatment of SIBO?
-Antibiotics- non systemic are preferred to reduce systemic resistance. Repeated courses are often required.
-probiotics afterwards
What is the treatment of bile acid malabsorption?
-Low fat diet
-colesevalam
-cholestyramine
What are the difficulties with bile acid binders?
They bind other medications as well. So have to leave a gap between them.
What is ulcerative colitis?
Chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of the large intestine
What percentage of IBD patients are IBD-U?
About 15%
What is the testing for UC?
-CRP, ESR, aneamia, albumin
-foecal calprotectin
-endoscopy
What is the gold standard testing for UC?
Endoscopy
What does foecal calprotectin test for?
Inflammation in the gut- makes it more likely to have IBD
What are the types of UC
-Proctitis- rectum
-left sided- up to the sphlenic flecture
-pancolitis- everything
