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GI/GU Illness > Malabsorption and Small Intestinal Neoplasms > Flashcards

Malabsorption and Small Intestinal Neoplasms Flashcards

1
Q

What are the causes of malabsorption? (7)

A
  1. defective intraluminal digestion
  2. primary mucosal cell abnormalities
  3. defective epithelial transport
  4. reduced small intestinal surface area
  5. lymphatic obstruction
  6. infection
  7. iatrogenic
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2
Q

What are examples of defective intraluminal digestion? (3)

A
  1. pancreatic insufficiency
  2. zollinger ellison syndrome
  3. inadequate emulsification of fat
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3
Q

What are examples of primary mucosal cell abnormalities? (1)

A

lactose intolerance

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4
Q

What is an example of defective epithelial transport? (2)

A
  1. abetalipoproteinaemia

2. primary bile acid malabsorption

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5
Q

What is an example of reduced small intestinal surface area? (2)

A
  1. gluten sensitive enteropathy

2. Crohn’s disease

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6
Q

What is an example Lymphatic obstruction? (2)

A
  1. lymphoma

2. TB

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7
Q

What are examples of infectious causes of malabsorption? (4)

A
  1. acute infectious enteritis
  2. parasitic infestation
  3. tropical sprue
  4. whipple disease
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8
Q

What are iatrogenic causes of malabsorption? (4)

A
  1. subtotal gastrectomy
  2. short gut syndrome
  3. distal ileal resection or bypass
  4. radiation enteropathy
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9
Q

What is the common presentation of malabsorption?

A

chronic diarrhoea

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10
Q

What are examples of malnutrition (not malabsorption)? (2)

A
  1. marasmus

2. Kwashiorkor

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11
Q

What are the most common malabsorption syndromes in the Western world? (3)

A
  1. coeliac disease
  2. pancreatic insufficiency
  3. Crohn’s disease
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12
Q

What causes coeliac disease?

A
  1. abnormal immune reaction to gluten which results in damage to the surface enterocytes of the small intestine and severely reduces their absorptive capacity
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13
Q

How does coeliac disease present in severe cases? (4)

A
  1. diarrhoea/steatorrhoea
  2. flatulence
  3. weight loss
  4. fatigue
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14
Q

What is the pathogenesis of coeliac disease? (6)

A
  1. Complex
  2. multifactorial
  3. incompletely understood
  4. environmental trigger
  5. genetically susceptible
  6. +/- immune dysregulation
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15
Q

What happens when gluten is consumed in coeliac disease? (7)

A
  1. consumption of gluten
  2. tissue transglutaminase released
  3. modification of gliadin from gluten proteins
  4. pathogenic T cells react to and are activated by modified gliadin
  5. mediate chronic intestinal inflammation
  6. epithelial damage resulting in villous atrophy, crypt hyperplasia and loss of brush border
  7. impaired resorption of nutrients in the small intestine
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16
Q

What is the genetic predisposition associated with coeliac disease? (2)

A
  1. HLA-DQ2

2. HLA-DQ8

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17
Q

What are the consequences of villous atrophy? (2)

A
  1. total malabsorption

2. lactose intolerance due to disaccharidase deficiency

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18
Q

Where is coeliac disease more severe? (2)

A
  1. duodenum

2. proximal jejunum

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19
Q

how can coeliac disease be diagnosed using tests?

A

detection of circulating tissue transglutaminase or anti-endomysial antibodies

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20
Q

How is coeliac disease definitively diagnosed? (3)

A
  1. clinical documentation of malabsorption
  2. histological confirmation on small bowel biopsy
  3. improvement in both symptoms and mucosal histology on gluten withdrawal from the diet
21
Q

What are the clinical associations of coeliac disease? (2)

A
  1. dermatitis herpetiformis

2. splenic atrophy

22
Q

What is the pathogenesis of dermatitis herpetiformis?

A

IgA against epidermal transglutaminase

23
Q

What are the complications of coeliac disease? (3)

A
  1. chronic ulcerative enteritis
  2. GI adenocarcinomas
  3. enteropathy associated T cell lymphoma
24
Q

What is tropical sprue?

A

pathological changed identical to those found in coeliac disease but less severe and more distal

25
Q

What are the features of tropical sprue? (5)

A
  1. chronic diarrhoea
  2. weight loss
  3. lethargy
  4. malaise
  5. macrocytic anaemia
26
Q

What is used to treat tropical sprue?

A

tetracyclines

27
Q

What causes giardiasis?

A

infection with giardia duodenalis

28
Q

What causes whipple disease?

A

tropheryma whippelii

29
Q

How does whipple disease present? (4)

A
  1. malabsorption
  2. lymphadenopathy
  3. arthralgia
  4. CNS involvement
30
Q

What is seen histologically in whipple disease?

A

infiltration of the lamina propria by numerous foamy macrophages

31
Q

How is whipple disease treated? (2)

A
  1. cephalosporin

2. co-trimoxazole

32
Q

What are the two types of lactase deficiency?

A
  1. congenital autosomal recessive

2. acquired

33
Q

How does lactase deficiency present? (3)

A
  1. fullness
  2. flatulence
  3. osmotic diarrhoea from unabsorbed lactose
34
Q

What is the cause of abetalipoproteinaemia?

A

faulty microsomal triglyceride transfer protein (MTP) gene (autosomal recessive)

35
Q

What is the pathogenesis of abetalipoproteinaemia?

A

impaired transepithelial transport of lipids from enterocytes to blood

36
Q

What is seen histologically in abetalipoproteinaemia?

A

lipid vacuoles visible in enterocytes

37
Q

What are the symptoms of abetalioproteinaemia? (3)

A
  1. steatorrhoea
  2. diarrhoea
  3. failure to thrive
38
Q

What is the presentation of small intestinal adenocarcinoma? (5)

A
  1. early obstructive jaundice
  2. obstruction
  3. nausea
  4. vomiting
  5. occult blood loss
39
Q

Where does small intestinal adenocarcinoma occur usually?

A

duodenum

40
Q

What is the major risk factor for small intestinal adenocarcinoma?

A

chronic inflammation associated with crohn’s disease

41
Q

What are the associations of small intestinal adenocarcinoma? (4)

A
  1. crohn’s disease
  2. familial adenomatous polyposis coli
  3. HNPCC
  4. Peutz Jegher’s syndrome
42
Q

What is the most common site for carcinoid tumours of the intestine?

A

appendix

43
Q

What cells are carcinoid tumours of the intestine derived from?

A

resident endocrine cells

44
Q

What occurs in carcinoid syndrome?

A

tumour secretion of serotonin

45
Q

When is carcinoid syndrome seen?

A

hepatic metastases

46
Q

How is carcinoid syndrome diagnosed?

A

excess 5HIAA in the urine

47
Q

What is associated with gastrointestinal lymphoma? (4)

A
  1. chronic gastritis
  2. chronic sprue like conditions
  3. mediterranean regions
  4. immunodeficiency
48
Q

What is immunoproliferative small intestinal disease associated with?

A

campylobacter jejuni

49
Q

How does immunoproliferative small intestinal disease present in young adults?

A
  1. malabsorption
  2. anorexia
  3. fever

GI/GU Illness (15 decks)

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