Small Bowel Disease and Investigations

Question 1

general presentations of small intestine malabsorption

Answer 1

weight loss
increased appetite
diarrhoea (sometimes steatorrhoea)
bloating
fatigue

Question 2

sign of vitamin A deficiency

Answer 2

night blindness

Question 3

sign of vitamin D deficiency

Answer 3

osteomalacia

Question 4

vitamins and minerals you become deficient in in small intestine malabsorption

Answer 4

iron, B12, vit A, C, D, K, calcium, magnesium

Question 5

what is thiamine

Answer 5

a type of vitamin B necessary in memory

Question 6

condition from vit C deficiency

Answer 6

scurvy

Question 7

where do crohn’s and coeliac’s both cause ulcers

Answer 7

apthous ulcers (mouth)

Question 8

dermatitis herpetiformis is a skin manifestation of…

Answer 8

coeliac disease

Question 9

what is deposited in the skin in dermatitis herpetiformis

Answer 9

IgA

Question 10

small bowel investigations (imaging)

Answer 10

endoscopy
barium 
CT
MRI enterography
capsule enterography

Question 11

test for bacterial overgrowth

Answer 11

H2 breath test (with laculose or glucose as the substrate)

culture of aspiration

Question 12

presentation of coeliac

Answer 12

weight loss
fatigue
vitamin deficiency
unexplained abdominal symptoms
dermatitis herpetiformis

Question 13

investigations in coeliac

Answer 13

serology for IgA
bloods for deficiencies
small-bowel 
HLA genetic testing (but 30% of GP have it so more useful for exclusion)
barium study to exclude other
distal duodenal biopsy is diagnostic

Question 14

what condition must be fulfilled for coeliac disease testing to be done

Answer 14

they must be on a gluten-CONTAINING diet

Question 15

what do you look for in coeliac disease biopsy

Answer 15

villous atrophy

Question 16

IgA in coeliac

Answer 16

anti endomysial IgA and tissue transglutaminase IgA

Question 17

pathophysiology of coeliac

Answer 17

gliadin part of gluten trigger inflammatory response –> villous atrophy –> malabsorption

Question 18

treatment of coeliac

Answer 18

withdraw gluten (refer to dietician)

Question 19

complications of coeliac

Answer 19

refractory coeliac disease
small bowel lymphoma
oesophageal carcinoma
colon cancer
small bowel adenocarcinoma

Question 20

what is whipple’s disease

Answer 20

a systemic infection cause by bacteria tropheryma whipplei. it causes malabsorption and abdominal pain

Question 21

5 I of malabsorption

Answer 21

Inflammation
Infection
Infiltration
Impaired motility
Iatrogenic

Question 22

treatment for bacterial overgrowth

Answer 22

rotating antibiotics and nutritional supplements