Small Bowel

Question 1

Stool osmotic gap calculation

Answer 1

290-2x[stoolNa + Stool K]. If 50mmol/L = secretory, If >100mmol/L = osmotic diarrhoea

Question 2

SIBO increased risk in scleroderma because of dismotility

Answer 2

Secretory diarrhoea, with raised folate and reduced B12. Diagnose with hydrogen breath test or endoscopy with cultures

Question 3

Immune tolerant HBV

Answer 3

Although high viral loads given normal LFTs, no need to treat. If significant inflammation in liver biopsy then treat

Question 4

H. Pylori serology is the only rest not afffected by recent bleeding or use of PPI

Answer 4

If negative biopsy in UgIB or recent PPI use, repeat serology to ensure no H pylori

Question 5

Unexplained iron deficient anaemia in DOWNS

Answer 5

Small bowel biopsy with TTg even with normal serology

Question 6

Bacillus cereus

Answer 6

Rice. 5 hours onset!

Question 7

Coeliac disease

Answer 7

Shortening of villi, lengthening of crypts, increased lymphocytes. Resembles severe topical sprue.
95% of patients are HLA DQ2/8 positive.
Arises from specific immune response to the alpha-gliadin component of gluten. The action of tissue transglutaminase on alpha-gliadin generates epitopes to CD4+ T-lymphocytes, which provoke an inflammatory response in the intestinal wall.In untreated individuals, alpha-gliadin specific CD4+ T cells can be found producing interferon-gamma in the intestinal wall.
Howell-Jolly bodies on blood film indicate hyposplenism and are consistent with a diagnosis of coeliac disease.

Question 8

SIBO

Answer 8

Risk factors: scleroderma, Crohns, previous bowel surgery

Question 9

Dermatitis herpetiformis is characterised by IgA at the dermo-epidermal junction.

Answer 9

Can get with Coeliacs