Lecture 30 Small Intestinal Disorders and Investigation

Question 1

Functions of the small intestine

Answer 1

Digestion
Absorption
Barrier function
Endocrine and neuronal control function

Question 2

Digestion of starch in stomach enzymes

Answer 2

o Salivary amylase

o Pepsin

Question 3

Digestion of proteins process

Answer 3

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

Question 4

Digestion of fat process

Answer 4

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

Question 5

Digestion of carbohydrate process

Answer 5

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

Question 6

What makes the small intestine a toxic environment

Answer 6

Digestive enzymes
Bile salts
Presence of IgA etc.

Question 7

How does the small intestine maintain a barrier against pathogens

Answer 7

Immune sampling
Translocation of bacteria
Gut Associated Lymphoid Tissue

Question 8

What are the tests of structure

Answer 8

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

Question 9

What is the Gold standard for imaging for small bowel

Answer 9

MRI enterograohy

Question 10

Name other assorted tests for the small bowell

Answer 10

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

Question 11

Symptoms of small bowel disease

Answer 11

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

Question 12

Define Steatorrhea

Answer 12

• Fat malabsorption

* High fat content in stool

Question 13

Signs of small bowel disease

Answer 13

• Signs of weight loss

* Low or falling BMI

Question 14

Signs of Vitamin A deficiency

Answer 14

Night blindness

Question 15

Signs of vitamin K deficiency

Answer 15

Raised Prothrombin

Question 16

Signs of Vitamin B deficiency

Answer 16

Memory, dementia

Question 17

Signs of Niacin deficiency

Answer 17

 Dermatitis, unexplained heart failure

Question 18

Signs of vitamin C deficiency

Answer 18

Scurvy

Question 19

What is clubbing a sign of

Answer 19

Crohn’s, Coeliac disease

Question 20

What is scleroderma a sign of

Answer 20

Systemic sclerosis

Question 21

What is Aphthous ulceration and what disease are they seen in

Answer 21

Coeliac, Crohn’s

Question 22

What is Dermatitis Herpetiforms

Answer 22

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

Question 23

Tests for coeliac disease

Answer 23

Serology

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

Question 24

Confirmatory tests for coeliac disease

Answer 24

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

Question 25

What test is a good exclusion test for coeliac disease

Answer 25

HLA status | 97% of coeliac are either HLA DQ2 or DQ8 positive

Question 26

What is Gliadin

Answer 26

Fraction of gluten which is responsible for the inflammatory response

Question 27

Treatment for coeliac disease

Answer 27

* Stop eating gluten | * Must refer to a state registered dietician

Question 28

Associated conditions with coeliac disease

Answer 28

* 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

Question 29

Complications of Coeliac Disease

Answer 29

* Refractory coeliac disease * Small bowel lymphoma * Oesophageal carcinoma * Colon cancer * Small bowel adenocarcinoma

Question 30

Infections that can cause malabsorption

Answer 30

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

Question 31

Treatment for small bowel bacterial overgrowth

Answer 31

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