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Alimentary System > Malabsorbtion and Small Intestinal Disease > Flashcards

Malabsorbtion and Small Intestinal Disease Flashcards

1
Q

what are four general functions of the small intestine?

A

> digestion
absorption
endocrine/neural functions
barrier to outside

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2
Q

how does the small intestine act as a barrier?

A

> immune sampling, bacteria pulled through the wall intact then smashed up by white blood cells that review their antigens
monitoring pathogen presence
translocation of bacteria
gut associated lymphoid tissue

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3
Q

why is breakdown controlled in the stomach?

A

to avoid osmotic shifts

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4
Q

where does protein digestion begin?

A

the small intestine

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5
Q

what system are glycerol and free fatty acids transported through within the body?

A

the lacteal and lymphatic system

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6
Q

what symptoms are seen with small intestinal disorders?

A 
> weight loss
> increased appetite
> diarrhoea
> bloating
> fatigue (v. vague)
> Steatorrhoea
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7
Q

how may patients describe steatorrhea (not the clinical definition but what patients may actually describe)?

A

> foul smell

> orange oil that floats

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8
Q

what signs are associated with small intestinal disorders?

A

falling/low BMI

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9
Q

what signs may specifically accompany calcium, magnesium and vitamin d deficiency?

A

> tetany (spasming/twitching of muscles)

> osteomalacia

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10
Q

what may vit. a deficiency cause?

A

night blindness

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11
Q

what are the signs of vit. k deficiency?

A

raised PT (prothrombin time)

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12
Q

what are signs of vit b complex deficiencies?

A

> thiamine: dementia

> niacin: dermatitis, unexplained heart failure

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13
Q

what are signs of vit. c deficiency?

A

scurvy

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14
Q

what conditions may cause clubbing?

A

coeliac or crohns

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15
Q

what may be causing sclerodoma?

A

systemic sclerosis

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16
Q

what is aphthous ulceration a general sign of?

A

coeliac and crohns

17
Q

describe dermatitis herpetiforms

A 
> cutaneous manifestation of coeliac disease
> blistering
> intense itching
> scalp, shoulders, elbows, knees
> IgA deposit in skin
18
Q

name some tests of the structure of the small bowel

A 
> small bowel biopsy (endoscopy)
> small bowel study (barium swallow)
> white cell scan
> CT scan
> MRI enterography
>capsule enterography
19
Q

how may you measure bacterial overgrowth?

A

> h2 breath test (lactulose/glucose substrate)

> culture of duodenal jejunal aspirate

20
Q

in a distal duodenal biopsy what three levels of villus atrophy are there?

A

> partial
subtotal
total

21
Q

what are coeliacs sensitive to in wheat, rye and barley?

A

gliadin fraction of gluten

22
Q

from what is gliadin absent?

A

rice and maize and oats (oats are mostly contaminated with wheat anyway due to farming methods)

23
Q

describe the pathology of coeliac’s disease

A

> inflammatory response (tissue transglutaminase)
partial/subtotal villus atrophy
increased intra-epithelial lymphocytes

24
Q

what test would you use to diagnose coeliac’s?

A

distal duodenal biopsy

25
Q

what serology is used to diagnose coeliac’s?

A

> anti endomysial IGA
anti tissue transglutaminase
anti-gliadin is useful in children but not adults

26
Q

what is the treatment for coeliac disease?

A

> withdraw gluten
refer to state registered dietitian
coeliac support group

27
Q

what conditions are associated with coeliacs?

A 
> Dermatitis herpetiformis
> IDDM
> Autoimmune thyroid disease
> Autoimmune hepatitis
> Primary Biliary cirrhosis
> Autoimmune gastritis
> Sjogren syndrome
> IgA deficiency
> Downs Syndrome
28
Q

what complications are associated with coeliacs?

A 
> refractory coeliac disease
> small bowel lymphoma
> oesophageal carcinoma
> colon cancer
> small bowel adenocarcinoma
29
Q

what inflammatory problems lead to malabsorption?

A

> coeliac disease

> crohns

30
Q

what infections lead to malabsorption?

A

> tropical sprue
HIV
giardia lamblia

31
Q

describe giardia lamblia

A

> unicellular parasite found in contaminated water

> responds to metronidazole

32
Q

what causes malabsorption?

A 
> whipples disease ( causative organism is tropheryma whippelii)
> infiltration
> impaired motility
> iatrogenic
> pancreatic disease
> inflammation
> infection
33
Q

describe the effects of whipples disease

A

> skin, brain, joints and cardiac effects
weight loss
abdominal pain
PAS material in the villi

34
Q

What pancreatic conditions can lead to malabsorption?

A

> Cystic fibrosis

> Chronic pancreatitis

35
Q

What infiltration conditions can lead to malabsorption?

A

Amyloidosis

36
Q

What conditions which cause impaired motility can result in malabsorption?

A

> Systemic sclerosis
Diabetes
Pseudo obstruction

37
Q

What are some iatrogenic causes of malabsorption?

A

> Gastric surgery
Short bowel syndrome
Radiation

Alimentary System (33 decks)

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