Small Bowel Disorders

Question 1

What are the functions of the small intestine?

Answer 1

Digestion - breaking of food into components
Absorption of nutrients
Endocrine/neuronal control functions - controlling flow of material from stomach to colon

Barrier function

Question 2

What are symptoms/signs of a small intestine disorder? (Including non-specific signs)

Answer 2

Weight loss
Increased appetite
Diarrhoea
Sometimes steatorrhea
Bloating
Fatigue

Clubbing (coeliac, Crohn’s)
Scleroderma (systemic sclerosis)
Aphthous ulceration (coeliac, Crohn’s)

Question 3

What investigations might be done in suspeced small bowel disorders?

Answer 3

Structure tests

• small bowel biopsy during endoscopy
• small bowel study (Barium)
• white cell scan
• CT
• MRI
• capsule enterography

Bacterial overgrowth - H2 breath test

Question 4

What is coeliac disease?

Answer 4

Sensitivity to gliadin fraction of gluten

- found in wheat, rye, barley

Question 5

What investigations might be done in suspected coeliac disease?

Answer 5

Distal duodenal biopsy (villous atrophy)

Serology

• anti endomysial IgA
• anti tissue transglutaminase (95% specific and sensitive)
• anti-gliadin may help in children

HLA status
- 97% of coeliacs are either DQ2 or DQ8 *but so are 30% of population)

Serology is ~ 90% sensitive/specific

IgA tests more reliable than IgG but only if you make IgA

Biopsy = gold standard

Question 6

What is the treatment for coeliac disease?

Answer 6

Withdrawing gluten from diet

Question 7

What are some conditions associated with coeliac disease?

Answer 7

Dermatitis herpetiformis - IgA deposit in skin
IDDM (T1D)
Autoimmune thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Autoimmune gastritis
Sjogren syndrome
IgA deficiency
Down's syndrome

Question 8

What are some complications of coeliac disease?

Answer 8

Refractory coeliac disease
Small bowel lymphoma
Oesophageal carcinoma
Colon cancer
Small bowel adenocarcinoma

Question 9

What are some other causes of small bowel malabsorption?

Answer 9

Crohn’s

Infections

• tropical sprue
• HIV
• giardia lamblia (parasite)

Whipple’s disease - very rare

Amyloid

Impaired motility

• systemic sclerosis
• diabetes
• pseudo-obstruction

Surgery
Radiation
Chronic pancreatitis
CF