Intestin grêle: pathologies Flashcards
What is Gee-Herter’s Disease?
Infantile form of celiac disease
What was described in 1936?
- Willem Karel Dicke
- Orphanage: stéatorrhée, delayed growth, malnutrition, edema (hypoalbuminemia), anemia (deficit in iron and folate), polyneuropathy (B12, vit. E), osteomalacia (Ca, vit. D)
What is stéatorrhée?
quantité anormalement élevée des graisses (lipides) dans les selles
How was celiac’s discovered?
WILLIAM K. DICKE
Experimentation in children with removing wheat from diet and replacing it with rice… symptoms go away when wheat is replaced… discovered association between Sx and eating wheat
What is the typical presentation of celiac’s in adult and children?
Chronic diarrhea > 3 months, steatorrhea, flatulence due to malabsorption, weight loss, delayed growth, fatigue, edema
Physical examination: dermatite herpétiforme
Labs: anemia (deficient in B12, folate, and iron), hypoalbuminaemia (problem with absorbing not liver)
What is dermatite herpétiforme?
intensely itchy, chronic papulovesicular eruptions, usually distributed symmetrically on extensor surfaces (buttocks, back of neck, scalp, elbows, knees, back, hairline, groin, or face)
What causes celiac?
Gluten and its derivatives (gliadine, glutenine) are not digested/absorbed properly
- Gliadine is absorbed and degraded by tissue transglutaminase (enterocytes)
What is the pathophysiology of celiac’s?
Patients with HLA DQ2, DQ8
- Auto immune rxn to degradation products of gliadine which leads to the formation of anti-gliadine antibodies and anti-transglutaminase antibodies
- Intolerance to gluten (gliadine)
What is the prevalence of celiac’s disease?
Currently increasing in pop. due to better testing (0.05% —> 1% of population)
How is celiac’s dx?
S/S: anemia, diarrhea, malnutrition
Blood test: test for anti-transglutaminase + IgA serum /anti-DGP (not done in clinic)
Biopsy: duodenal biopsy (villosity atrophy)… redo after gluten is eliminated —> restored villosities
What does celiac’s look like… histologically?
Atrophy of villosities w/ aug. in immune cells (T-cells)
No “bordure en brosse” —> cells constantly multiplying and being replaced so no time for BenB to form
How is celiac’s treated?
Diet w/o gluten: villosity (seigle, avoine, blé, orge) —> (rye, oats, wheat, barley)
What’s ok?: rice, corn, soya
Take vitamins to replenish deficit due to diarrhea until replenished
What is non-celiac gluten intolerance?
Not really known… but diet w/o gluten improves symptoms
What are some complications of celiac’s?
Increased risk for neoplasms… (not really sure anymore):
- Lymphoma due to inc. T-cell presence
-
Cancer épidermoïde de l’oesophage
- people with untreated celiac disease have a higher risk, but this risk decreases with time after diagnosis, probably due to the adoption of a gluten-free diet, which seems to have a protective role against development of malignancy in people with celiac diseas
- Adenocarcinoma of the small intestine… ??? not really sure but used to think it was due to increased multiplication/regeneration of cells —> inc. chances of mutations
Other: ulcerations, perforation, stricture (abnormal narrowing of passage)
Are tumours in the small intestine common?
NO… quite rare (benign and malignant)
What are the different kinds of tumours that can be found in the small intestine? BENIGN VS MALIGNANT (9)
What is invagination grêle-grêle?
Intussusception: serious condition in which part of the intestine slides into an adjacent part of the intestine due to peristalsis
How are carcinoid tumours dx?
Urine: 24 hour collection to test for 5-HIAA
Serum: chromogranine A —> 100x the normal
Octreoscan to localize tumour
