Small Bowel Diseases Flashcards
Symptoms
Weight loss Increased appetite Bloating Fatigue Diarrhoea Steatorrhoea
Signs of Specific Nutrient Deficiencies
Vit A - night blindness Vit B: Thiamine - memory, Niacin - dermatitis, unexplained HF Vit C - scurvy Vit D, Ca, Mg - osteomalacia, tetany Vit K - Raised PTR
What small intestinal diseases can clubbing be a sign of
Coeliac and Crohns
What diseases can scleroderma be a sign of
systemic sclerosis
What small intestinal diseases can aphthous ulceration
Coeliac and crohns
What is dermatitis herpetiformis
a cutaneous manifestation of coeliac disease where IgA deposits in skin causing itchy blisters on the scalp, shoulders, elbows and knees
Investigations for small bowel disease
Small bowel biopsy with endoscopy
White cell scan
Imaging Investigations for small bowel disease
Small bowel study with barium
CT scan
MRI enterography (younger IBD patient)
Tests for bacterial overgrowth
H2 Breath test
Duodenal / jejunal aspirate culture
Serology tests for coeliac
- Total IgA
- IgA transglutaminase antibody (IgA tTG)
- IgA endomysial antibodies (if tTG is weakly +ve)
Coeliac serology tests to do incase of IgA deficiency
IgG
Goldstandard diagnostic test for coeliac
Distal duodenal biopsy showing villous atrophy
Why does villous atrophy occur in coeliac?
gluten produces an inflammatory response via tissue transglutaminase (thought to be).
this leads to villous atrophy and increased intra-epithelial lymphocytes
What is coeliac disease
sensitivity to gluten causing the small intestine to become inflammed and unable to absorb nutrients
which fraction of gluten is the sensitivity to and which foods is it found in?
a-Gliadin
Wheat, rye and barley
Treatment for coeliac
Gluten withdrawal
Refer to dietician
Associated conditions with coeliac
Dermatitis Herpetiformis Diabetes mellitus Autoimmune - thyroid, gastritis, hepatitis Sjogren syndrome IgA deficiency Down's syndrome Primary biliary cirrhosis
Coeliac complications
Refractory coeliac disease
Small bowel lymphoma and adenocarcinoma
Oesophageal and colon carcinoma
Inflammation causes of malabsorption
Crohns
Coeliac
Infection causes of malabsorption
HIV
Giardia
Tropical sprue
Whipples disease (tropheryma whippelii)
Infiltration causes of malabsorption
Amyloidosis
Impaired motility causes of malabsorption
systemic sclerosis
diabetes
pseudo obstruction
Iatrogenic causes of malabsorption
Gastric surgery
Short bowel syndrome
Radiation
Pancreatic causes of malabsorption
Chronic pancreatitis
Cystic fibrosis
What finding on an abdominal x-ray would be in keeping with small bowel obstruction
Central distribution of loops of bowel
