Small Bowel Flashcards
95% of bile acids are absorbed by?
Terminal ileum
Liver can compensate for lost bile acids until this amount of ileal resection?
Leads to?
Therapeutic importance?
100 cm
Fat malabsorption and steatorrhea
Bile acid sequestrants worsen symptoms instead of improve then (as in <100 cm resections)
Treatment for fat malabsorption Secondary to large ileal resection?
Low fat diet, medium chain fatty acids (MCFAs don’t require bile for absorption)
Peptide YY - Function? Released by? Trigger for release?
Slow upper gastrointestinal motility
Ileum
Response to fat in Small bowel
Cut off for abnormal stool Sudan stain? Fecal fat?
> 5 fat globules/HPF
> 7g fat in 24 hours (After ingestion of 100 g fat per day for three days prior to test)
Lab Tests to investigate fat malabsorption?
LFTs (PBC, PSC)
Celiac serologies
Fecal elastase (pancreatic insufficiency)
D-Xylose (Abnormal suggests small intestinal mucosal disease)
Two general etiologies of protein losing enteropathy?
Mucosal disease (erosive and non-erosive) versus increased interstitial pressure
Etiologies of protein losing enteropathy from increased interstitial pressure?
Heart disease, post Fontan, portal hypertension, mesenteric TB
Best method to evaluate enteric protein loss? Abnormal threshold?
24 hour A1AT
> 27 if no diarrhea
56 With diarrhea
24 hour A1AT - false negative mechanism? Prevent by?
Pepsin degrades A1AT.
Start patient on PPI
Imaging test for protein losing enteropathy?
Technician 99-labeled albumin
Tests for carbohydrate malabsorption evaluation? (5)
Fecal pH <5.5
Stool osmotic gap > 100
D-Xylose test (<20; urine <4)
Hydrogen breath test
Lactose tolerance test (increase <20 mg/dL)
Most common bacterial species in the proximal intestine?
Streptococcus, lactobacillus
Most common bacteria species in the colon?
Bacterioid, clostridium, bifidobacterium
Lab suggestive of SIBO?
Increased folate (from bacterial production), low B12 (bacterial consumption)
