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Alimentary System > Lecture 30 Small Intestinal Disorders and Investigation > Flashcards

Lecture 30 Small Intestinal Disorders and Investigation Flashcards

1
Q

Functions of the small intestine

A

Digestion
Absorption
Barrier function
Endocrine and neuronal control function

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2
Q

Digestion of starch in stomach enzymes

A

o Salivary amylase

o Pepsin

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3
Q

Digestion of proteins process

A

o Broken down to oligopeptides & amino acids
o Trypsin activates chymotrypsin by cleaving peptidic bonds
o Final hydrolysis and absorption at brush border

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4
Q

Digestion of fat process

A

o Pancreatic lipase
 Absorption of glycerol and free fatty acids
 via lacteal and lymphatic system

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5
Q

Digestion of carbohydrate process

A

o Pancreatic amylase
 Breakdown to disaccharides
 Final digestion by brush border disaccharidase

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6
Q

What makes the small intestine a toxic environment

A

Digestive enzymes
Bile salts
Presence of IgA etc.

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7
Q

How does the small intestine maintain a barrier against pathogens

A

Immune sampling
Translocation of bacteria
Gut Associated Lymphoid Tissue

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8
Q

What are the tests of structure

A

• Small bowel biopsy
o Endoscopy
• CT Scan- not very sensitive to small bowel
• MRI enterography- Gold standard- no ionizing radiation
• Capsule enterography

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9
Q

What is the Gold standard for imaging for small bowel

A

MRI enterograohy

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10
Q

Name other assorted tests for the small bowell

A

• Small bowel biopsy
o Endoscopy
• CT Scan- not very sensitive to small bowel
• MRI enterography- Gold standard- no ionizing radiation
• Capsule enterography

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11
Q

Symptoms of small bowel disease

A 
•	Weight Loss
•	Increased appetite
•	Diarrhoea
o	Usually watery
o	Sometimes steatorrhoea
•	Bloating
•	Fatigue
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12
Q

Define Steatorrhea

A
  • Fat malabsorption

* High fat content in stool

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13
Q

Signs of small bowel disease

A
  • Signs of weight loss

* Low or falling BMI

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14
Q

Signs of Vitamin A deficiency

A

Night blindness

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15
Q

Signs of vitamin K deficiency

A

Raised Prothrombin

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16
Q

Signs of Vitamin B deficiency

A

Memory, dementia

17
Q

Signs of Niacin deficiency

A

 Dermatitis, unexplained heart failure

18
Q

Signs of vitamin C deficiency

A

Scurvy

19
Q

What is clubbing a sign of

A

Crohn’s, Coeliac disease

20
Q

What is scleroderma a sign of

A

Systemic sclerosis

21
Q

What is Aphthous ulceration and what disease are they seen in

A

Coeliac, Crohn’s

22
Q

What is Dermatitis Herpetiforms

A 
•	Cutaneous manifestation of coeliac disease
o	Blistering
o	Intensely itchy
o	Scalp, shoulders, elbows, knees
o	IgA deposit in skin
23
Q

Tests for coeliac disease

A

Serology

IgA test more reliable for IgG but only if you make IgA as 0.1 to 1% of population have IgA deficiency

24
Q

Confirmatory tests for coeliac disease

A

Distal duodenal biopsy for villous atrophy (partial, subtotal, total), increased intra-epithelial lymphocytes

25
Q

What test is a good exclusion test for coeliac disease

A

HLA status

97% of coeliac are either HLA DQ2 or DQ8 positive

26
Q

What is Gliadin

A

Fraction of gluten which is responsible for the inflammatory response

27
Q

Treatment for coeliac disease

A
  • Stop eating gluten

* Must refer to a state registered dietician

28
Q

Associated conditions with coeliac disease

A
  • Dermatitis herpetiformis
  • IDDM- Insulin-Dependent Diabetes Mellitus, now known as Diabetes mellitus type 1, an autoimmune disease resulting in the destruction of insulin-producing cells
  • Autoimmune thyroid disease
  • Autoimmune hepatitis
  • Primary Biliary Cholangitis
  • Autoimmune gastritis
  • Sjogren’s syndrome
  • IgA deficiency
  • Down’s Syndrome
29
Q

Complications of Coeliac Disease

A
  • Refractory coeliac disease
  • Small bowel lymphoma
  • Oesophageal carcinoma
  • Colon cancer
  • Small bowel adenocarcinoma
30
Q

Infections that can cause malabsorption

A 
Tropical sprue
HIV
Giardia lamblia
Whipple's Disease
Amyloid
Systemic sclerosis
Diabetes
Pseudo obstruction
Iatrogenic
31
Q

Treatment for small bowel bacterial overgrowth

A 
◦	Rotating antibiotics
	Metronidazole
	Tetracycline
	Amoxicillin
	Each for 2 weeks
◦	Vitamin and nutritional supplements

Alimentary System (39 decks)

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