Malabsorption and Small Intestine Disease

Question 1

What are the functions of the small intestine?

Answer 1

Digestion
Absorption
Endocrine and neuronal control functions

Question 2

What is the digestive function of the small intestine?

Answer 2

The breaking down of food into its components

Components that can then be absorbed

Question 3

What is the absorption function of the small intestine?

Answer 3

The passage of nutrients into the blood stream

Question 4

Describe the structure of the small intestine

Answer 4

3 pars 
Duodenum 
Jejunum
Ileum 
Large surgace area 
Covered in villi 
Villi covered in microvill

Question 5

Does the large intestine frequently turn over its cells?

Answer 5

Yes very

Question 6

Why is the rarity of malignancy of the small intestine so surprising?

Answer 6

Because of the high cell turnover rate

Question 7

Describe the bacterial population in the small intestine

Answer 7

Low bacterial population

Question 8

Why do most bacterial not survive in the small intestine?

Answer 8

Because bile is incredibly toxic

Question 9

Where does digestion commence?

Answer 9

In the stomach

Question 10

How is fat digested?

Answer 10

By pancreatic lipase
Absorption of glycerol and free FA
Via lacteal and lymphatic system

Question 11

Hows are carbohydrates absorbed?

Answer 11

Pancreatic amylase
Breakdown to disaccharides
Final digestion by brush border

Question 12

What are the symptoms of general malnutrition?

Answer 12

Weight loss
Increased appetite
Diarrhoea
Fatigue

Question 13

What causes steatorrhea?

Answer 13

Fat malabsorption

Question 14

What is steatorrhea?

Answer 14

High fat content in stools

Stools are lens dense and float

Question 15

How does steatorrhea present?

Answer 15

Floating stools
Foul smelling
May leave an oily mark

Question 16

What are signs of general malnutrition?

Answer 16

Signs of weight loss

Low of falling BMI

Question 17

What are signs of iron deficiency?

Answer 17

Anaemia
Painful tongue
Angular stomatitis

Question 18

What are some non-specific signs in malnutrition?

Answer 18

Clubbing
Scleorderma
Apththous ulceration

Question 19

What is aphthous ulceration?

Answer 19

Mouth ulcers

Question 20

What investigations are done for the small bowel?

Answer 20

Small bowel biopsy 
Small bowel study
White cell scan 
CT scan 
MRI enterography
Capsule enteropraphy

Question 21

What can clubbing be a sign of in small bowel disease?

Answer 21

Crohn’s

Coeliac disease

Question 22

What is a White cell scan?

Answer 22

• WBC are removed and tagged with radioactive material

- Injected back into locate the site and extent of inflammation

Question 23

Is coeliac disease common or uncommon?

Answer 23

Common

Question 24

Why is coeliac disease considered to be an iceberg?

Answer 24

Because so many people go undiagnosed

Question 25

What are coeliacs sensitive to?

Answer 25

The Gliadin fraction of gluten

Question 26

Where is gliadin (of gluten) found food wise?

Answer 26

Wheat Rye Barley

Question 27

Where is the gold standard of coeliac diagnosis?

Answer 27

Distal duodenum biopsy

Question 28

What does gliadin do in coeliac?

Answer 28

Produces an inflammatory response

Question 29

How is the inflammatory response in coeliac thought to be mediated?

Answer 29

Via tissue transglutaminase

Question 30

What is the pathological appearance of coeliac?

Answer 30

Partial or subtotal villous atrophy | Increased intra-epithelial lymphocytes

Question 31

What are the potential complications of coeliac?

Answer 31

``` o Refractor coeliac disease o Small bowel lymphoma - rare o Oesophageal carcinoma o Colon cancer o Small bowel adenocarcinoma ```

Question 32

How is coeliac diagnosed?

Answer 32

Distal duodenal biopsy Serology IgA Total plasma IgA

Question 33

What is the difference between partial, subtotal and total villous atrophy?

Answer 33

Partial - shortened villi Subtotal - the lining is flat with extended glands Total - the lining is down to a thin line

Question 34

What is the treatment for coeliac?

Answer 34

Withdraw gluten | Refer to a state registered dietician

Question 35

What are causes of malabsorption?

Answer 35

``` Inflammation Infection Whipples Disease Impaired gut motility Iatrogenic Pancreatic problems Infiltration Tropheryma Whippelii ```

Question 36

What inflammatory diseases can cause malabsorption?

Answer 36

Coeliac | Crohn's

Question 37

What pancreatic conditions can cause malabsorption?

Answer 37

Chronic pancreatitis | CF

Question 38

What skin condition is associated with coeliac

Answer 38

Dermatitis Herperiformis

Question 39

Diagnostic procedure for coeliac

Answer 39

Distal duodenal biopsy

Question 40

Histological finding of coeliac disease

Answer 40

Partial or total villous atrophy

Question 41

Commonest treatment for coeliac disease

Answer 41

Removal of gluten from diet

Question 42

Cause of coeliac disease

Answer 42

Autoimmune inflammatory response to harmless gliadin fraction of gluten