MISCELLANEOUS INTESTINAL DISEASES Flashcards
What is a protein-losing enteropathy?
Intestinal conditions that lead to protein loss into the GIT and usually manifest with hypoalbuminaemia - occasionally hepatic synthesis of albumin cannot compensate for the protein loss and so peripheral oedema dominates the clinical picture
Can also cause congestive heart failure or constrictive pericarditis
What are the causes of protein-losing enteropathy?
Crohn’s disease
Tumours
Menetriers disease
Coeliac disease
Lymphatic disorders
IBD
How is a protein-losing enteropathy diagnosed?
By measuring serum albumin and protein levels
Confirmed by measurement of alpha1 antitrypsn clearance - measured in stool (this protein is resistant to proteolysis)
How is protein-losing enteropathy managed?
Usually by treating the underlying condition
How can tuberculosis affect the GIT?
Reactivation of the primary disease can cause terminal ileitis
Note its an uncommon clinical manifestation of TB
Possible pathophysiology includes swallowing sputum with direct seeding, haematoigenous spread or ingestion of milk from cows affected with bovine TB
What are the clinical features of intestinal TB?
Abdo pain, weight loss, anaemia, fever with night sweats, obstruction, RIF pain, palpable mass
1/3rd of pt present acutely with intestinal obstruction or generalised peritonitis
50% will have x-ray evidence of pulmonary TB
What is eosinophilic gastroenteritis?
In this condition of unknown aetiology there is eosinophilic infiltration and oedema of any part of the gastrointestinal mucosa.
The gastric antrum and proximal small intestine are usually involved, hosting either a localized lesion (eosinophilic granuloma) or diffuse sheets of eosinophils in the serosal and submucosal layers.
What conditions is eosinophilic gastroenteritis associated with?
There is an association with asthma, eczema and urticaria.
Outline how eosinophilic gastroenteritis can present?
In the 3rd decade
Abdo pain, nausea, vomiting, upper GI bleeding
How is eosinophilic gastroenteritis diagnosed?
Endoscopic biopsy
Radiology may show mass lesions
How is eosinophilic gastroenteritis managed?
Corticosteroids for the widespread infiltration
What is intestinal lymphangiectasia?
Rare disorder characterised by dilated lymph vessels supplying the lining of the small intestine leading to an excessive loss of serum proteins and lymphocytes into the GIT
It may occur as an idiopathic primary condition - Waldmanns disease. Or it may be secondary to lymphatic obstruction or elevated lymphatic pressure
It’s a protein-losing enteropathy
How does intestinal lymphangiectasia present?
Hypoproteinaemia with ankle oedema is the main feature.
Variable intestinal symptoms - diarrhoea, abdo pain, vomiting and nausea. Failure to thrive
May produce steatorrhoea
How is intestinal lymphangiectasia diagnosed?
Dilated lacteals on jejunal biopsy
White-tipped villi on capsule endoscopy
Serum immunoglobulin levels are reduced with low circulating lymphocytes
How is intestinal lymphangiectasia managed?
Low-fat diet
Mid chain triglycerides and fat-soluble vitamin supplements as required
Octreotide has had a dramatic effect in a few primary cases but the moa is unknown
