GI: small bowel

Question 1

What percentage of nutrients does the small bowel absorb from the diet?

Answer 1

90%

Question 2

What key vitamin does the large bowel (colon) absorb?

Answer 2

Magnesium

Question 3

What is the definiton of coeliac disease?

Answer 3

an immune-mediated small intestinal enteropathy that is triggered by exposure to dietary gluten in genetically predisposed people

Question 4

What physiological state does coeliac disease lead to that can make nutrient absorption poor?

Answer 4

villous atrophy- most commonly in proximal small bowel

Question 5

What genes are coeliac disease associated with?

Answer 5

HLA genes DQ2 and DQ8

Question 6

What are the symptoms of coeliac disease?

Answer 6

diarrhoea, bloating, abdominal pain, weight loss, fatigue, rash, sometimes no symptoms

Question 7

Why do you get anaemia with coeliac?

Answer 7

Iron deficiency anaemia due to malabsorption

Question 8

How do you diagnose coeliac disease?

Answer 8

Transglutaminase antibody, EMA- have to be still eating gluten to test positive. Duodenal biopsy sometimes required

Question 9

Why might someone test negative for TTG/EMA if they have coeliac disease?

Answer 9

If patient is IgA deficient (1 in 300)

Question 10

How effective is GF diet in coeliac disease?

Answer 10

99%

Question 11

What are the treatments for coeliac disease?

Answer 11

Gluten free diet
Vitamin supplementation- calcium and vitamin D
Vaccination against pneumococcus

Question 12

What are the complications of coeliac disease?

Answer 12

-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

Question 13

What type of fibre should some people avoid when they have IBS?

Answer 13

insoluble fibre

Question 14

What is small intestine bacterial overgrowth?

Answer 14

The presence of excessive bacteria in the small intestine. Can present a bit like irritible bowel syndrome.

Question 15

How do you test for SIBO?

Answer 15

Lactulose hydrogen breath test, duodenal aspirate and culture

Question 16

What is the treatment of SIBO?

Answer 16

-Antibiotics- non systemic are preferred to reduce systemic resistance. Repeated courses are often required.
-probiotics afterwards

Question 17

What is the treatment of bile acid malabsorption?

Answer 17

-Low fat diet
-colesevalam
-cholestyramine

Question 18

What are the difficulties with bile acid binders?

Answer 18

They bind other medications as well. So have to leave a gap between them.

Question 19

What is ulcerative colitis?

Answer 19

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

Question 20

What percentage of IBD patients are IBD-U?

Answer 20

About 15%

Question 21

What is the testing for UC?

Answer 21

-CRP, ESR, aneamia, albumin
-foecal calprotectin
-endoscopy

Question 22

What is the gold standard testing for UC?

Answer 22

Endoscopy

Question 23

What does foecal calprotectin test for?

Answer 23

Inflammation in the gut- makes it more likely to have IBD

Question 24

What are the types of UC

Answer 24

-Proctitis- rectum
-left sided- up to the sphlenic flecture
-pancolitis- everything

Question 25

What is crohn’s disease?

Answer 25

Inflammatory bowel disease that causes chronic inflammation of the GI tract, which extends from your stomach all the way down to your anus. Chronic inflammatory trans-mural inflammation

Question 26

What are the symptoms of crohns disease?

Answer 26

diarrhoea, fistulas around the rectum, abdominal pain, weight loss, perianal abscesses, oral ulceration