Malabsorption and small intestinal disease Flashcards

1
Q

What are the main functions of the small intestine?

A

Digestion, absorption, endocrine and neural control and barrier functions

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2
Q

List 4 ways in which the small intestine acts as a barrier against pathogens

A

gut associated lymphoid tissue
immune sampling
monitor pathogen presence
translocation of bacteria

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3
Q

What is the average adult length of the small intestine and what age is this achieved by?

A

2.5-4.5m

11 years old

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4
Q

What makes up the toxic environment of the small intestine? what is the result of this?

A

bile salts, IgA, enzymes

low bacterial population

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5
Q

Why is digestion controlled?

A

to avoid osmotic shifts

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6
Q

What constituents are proteins broken down to and what enzyme controls this?

A

oligopeptides and amino acids

trypsin

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7
Q

What are the symptoms of malabsorption?

A

weight loss
increased appetite in severe malabsorption
steatorrhoea

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8
Q

Briefly describe steatorrhoea - cause, appearance etc

A

malabsorption of fat which leads to fat in the faeces giving a very high content of fat in the stool. This results in a less dense, pale, foul smelling stool which floats. Often complaints about leaving an oily mark.

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9
Q

What is scleroderma an indicator effect and what can this effect in the gut?

A

systemic sclerosis

motility

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10
Q

What illnesses can clubbing and aphthous ulceration be an indicator of?

A

crohns and coeliac

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11
Q

What is the cutaneous manifestation of coeliac disease called?

A

dermatitis herpetiforms

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12
Q

What is dermatitis herpetiforms like?

A

intensely itchy found at elbows, knees, shoulders and scalp with blistering

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13
Q

What is dermatitis herpetiforms due to?

A

IgA deposit in the skin

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14
Q

Are there more investigations for structure or function of the gut?

A

structure

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15
Q

What are some tests of structure of the small bowel?

A

endoscopy - biopsy

barium meal, MRI enterography, capsule enterography, CT, white cell scan

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16
Q

What test can be done for suspected bacterial overgrowth?

A

H2 breath test

17
Q

What is villous atrophy associated with?

A

absorption disruption

18
Q

What is coeliac disease due to?

A

sensitivity to giadin in gluten

19
Q

What foods is gluten found in?

A

wheat, barley, rye - not in oats but oats are usually made in contact with the others so are common to be contaminated so coeliacs usually eat special oats

20
Q

An inflammatory response is produced via what antibody in coeliac disease?

A

tissue transglutaminase

21
Q

List the steps of the pathology behind coeliac disease

A

After inflammatory response there is also villous atrophy be it partial or subtotal, increased intra epithelial lymphocytes

22
Q

How is coeliac disease diagnosed?

A

Via distal duodenal biopsy and serology - anti tissue transglutaminase and anti endosymal IgA

23
Q

How is coeliac disease treated?

A

remove gluten from diet - refer to dietitian

24
Q

List some associated conditions with coeliac disease

A

autoimmune hepatitis, primary biliary cirrhosis, autoimmune thyroid disease, autoimmune gastritis, downs syndrome, dermatitis herpetiforms

25
List some complications of coeliac disease
small bowel lymphoma, colon cancer, oesophageal cancer, small bowel adenocarcinoma, refractory coeliac disease
26
Inflammatory causes of malabsorption
coeliac disease | crohns
27
Infection causes of malabsorption
tropical sprue HIV gardia lambia - parasite found in infected water
28
Pancreatic causes of malabsorption
chronic pancreatitis, cystic fibrosis
29
What is whipples disease?
``` caused by tropheryma whippeli effects middle aged men weight loss, malabsorption, abdo pain skin, brain, joints and cardiac treated with antibiotics ```
30
Infiltration causes of malabsorption?
amyloid
31
Impaired motility causes of malabsorption?
systemic sclerosis diabetes pseudo obstruction
32
Iatrogenic causes of malabsorption?
radiation short bowel syndrome gastric surgery