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Y1 - Gatrointestinal > Malabsorption > Flashcards

Malabsorption Flashcards

1
Q

What disorders of the small intestine cause malabsorption?

A 
Coeliac
Dermatitis herpetiformis
Tropical Sprue
Bacterial overgrowth
Intestinal resection
Whipple's disease
Radiation enteropathy
Parasite infection
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2
Q

What is coeliac disease?

A

A condition where there is inflammation of the mucosa of the upper small bowel that improves when gluten is taken out of the diet but relapses when it is reintroduced

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3
Q

Which cereals are entirely made of gluten?

A

Wheat
Barley
Rye

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4
Q

What are prolamins?

A

Damaging factors that are resistant to digestion and trigger immune responses

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5
Q

In coeliac disease does mucosal damage decrease towards the duodenum or ileum?

A

Ileum

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6
Q

What are some symptoms of coeliac disease?

A 
Tiredness
Malaise
Diarrhoea
Steatorrhoea
Abdominal pain
Weight loss
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7
Q

How is coeliac disease diagnosed (in all but clear cut cases)?

A

Small bowel biopsy

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8
Q

Other than small bowel biopsy, what else is sufficient to diagnose coeliac disease?

A

Serology - tissue transglutamase

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9
Q

What are the histological features of coeliac disease?

A

Villous atrophy

Crypt hyperplasia

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10
Q

What are the indications for serological testing for coeliac disease?

A 
Persistent diarrhoea
Folate or iron deficiency
Unexplained abnormal LFTs
Family history of coeliac disease
Associated autoimmune disease
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11
Q

What antibodies do standard serological tests use for coeliac disease?

A

IgA

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12
Q

Why might haematology be done for coeliac disease?

A

To check for anaemia and folate deficiency

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13
Q

Why might biochemistry be done for coeliac disease?

A

In severe cases there may be osteomalacia or hypoalbuminaemia

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14
Q

What imaging might be done for coeliac disease?

A

Small bowel barium follow through

or MRI

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15
Q

Why might imaging be done for coeliac disease?

A

Mainly when a complication such as lymphoma is suspected

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16
Q

Why might bone densitometry be done for coeliac disease?

A

There is a risk of osteoporosis

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17
Q

Why might a capsule endoscopy be done for coeliac disease?

A

To look for gut abnormalities when complication is suspected

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18
Q

What may initially be needed in coeliac disease?

A

Replacement vitamins

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19
Q

What is the management for coeliac disease?

A

Gluten free diet for life

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20
Q

What is dermatitis herpetiformis?

A

A blistering, sub-epidermal eruption of the skin associated with gluten-sensitive enteropathy

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21
Q

Is dermatitis herpetiformis common?

A

No

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22
Q

What is the management for dermatitis herpetiformis?

A

Dapsone for the skin

Gluten free diet

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23
Q

What is non-coeliac gluten intolerance?

A

Patients who are sensitive to gluten but coeliac serology is negative and biopsies are normal

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24
Q

What is tropical sprue?

A

Severe malabsorption accompanied by diarrhoea and malnutrition

25
What are the symptoms of tropical sprue?
Diarrhoea Abdominal distension Weight loss Anorexia
26
How long after leaving the tropics can tropical sprue present?
Can be weeks or many years
27
How is tropical sprue managed?
Most see improvement after leaving the sprue area and taking folic acid Also may require and antibiotic (usually tetracycline)
28
What is bacterial overgrowth usually found in association with?
Structural abnormality of the small intestine such as stricture or diverticulum
29
What are the clinical features of bacterial overgrowth?
Diarrhoea | Steatorrhoea
30
What causes steatorrhoea?
Deficiency in unconjugated bile salts
31
How is bacterial overgrowth diagnosed?
Hydrogen breath test
32
What is classed as small bowel syndrome?
When less than 1m of continuous small bowel remains
33
Resection of which is better tolerated, jejunum or ileum?
Jejunum
34
After ileal resection, which substances tend to be deficient?
Bile salts | Vitamin B12
35
Why might diarrhoea occur after ileal resection?
The mechanism where oligopeptides that reach the ileum without being absorbed delay gastric emptying to allow more absorption is lost. Less absorption of fluids leads to diarrhoea
36
What can happen after ileal resection?
Bile salt induced diarrhoea Steatorrhoea and gallstone formation Oxaluria and oxalate stones B12 deficiency
37
Why might steatorrhoea and gallstone formation happen after ileal resection?
Decreased bile salt absorption means less bile reaching the gallbladder, causing lithygenic bile and gallstone formation
38
What investigations might be done in ileal resection?
Imaging of small bowel Measurement of B12 Bile salt retention test (SeHCAT) Hydrogen breath test
39
What might jejunal resection lead to?
Gastric hypersecretion
40
In which resection might adaptation take place that increases absorption?
Jejunal
41
What can intestinal failure result from?
``` Obstruction Dysmotility Surgical resection Congenital defect Disease associated loss of absorption ```
42
What is short bowel syndrome characterised by?
Inability to maintain protein-energy, fluid, electrolyte or micronutrient balance
43
When does short bowel syndrome most commonly occur?
Following resection for CD Mesenteric vessel occlusion Radiation enteritis Trauma
44
What are the two possible situations that can occur in short bowel syndrome?
Shortened small intestine ending at a terminal small bowel stoma Shortened small intestine in continuity with the colon
45
What is the major problem when the small intestine ends at a terminal small bowel stoma?
Sodium and fluid depletion
46
What is Whipple's disease?
A rare infectious bacterial disease
47
What organism is Whipple's disease caused by?
Troptheryma whipplei
48
Who are the majority of Whipple's patients?
Males, usually white and middle aged
49
What are the symptoms of Whipple's disease?
``` Arthritis and arthralgia, progressing over years to: Weight loss Diarrhoea Abdominal pain Fever Peripheral lymphadenopathy ```
50
What do blood tests show in Whipple's disease?
Chronic inflammation | Malabsorption
51
How is diagnosis of Whipple's made?
Small bowel biopsy
52
How can T. Whipplei antibodies be identified?
Immunochemistry
53
How is T. whipplei managed?
Antibiotics that cross the blood brain barrier | Trimethoprim or sulfamethoxazole
54
What are the chronic affects of radiation?
Muscle fibre atrophy Ulcerative changes due to ischaemia Obstruction due to radiation induced fibrotic structures
55
What areas are most commonly affected by radiation emesis?
Ileum | Rectum
56
What symptoms may occur during irradiation?
Nausea and vomiting Diarrhoea Abdominal pain
57
What does acute radiation damage cause?
Radiation proctitis with diarrhoea and tenesmus, with or without blood
58
What are the features of giardia infection?
Diarrhoea | Malabsorption with steatorrhoea
59
What is the feature of cryptosporidiosis infection?
Malabsorption

Y1 - Gatrointestinal (31 decks)

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