Small bowel pathology Flashcards
What is the toxic agent released from gluten?
Gliadin
What are some of the symptoms of coeliacs disease?
General malaise/tiredness (?iron deficiency anaemia) Diarrhoea Nausea Vomiting Bloating Angular stomatitis Weight loss Oral ulceration Osteomalacia
What is coeliacs disease?
A T-cell mediated autoimmune disease in which the body has an adverse reaction to the breakdown products of gluten (gliadins)
Which antibodies in coeliacs disease are produced in response to gliadins?
Anti-gliadin
Anti-endomysial
What is the autoimmune antibody produced in coeliacs disease and what does it do?
Anti-endomysial antibody
Attacks the tissue transglutaminase resulting in the abnormal breakdown of gluten
What changes in the small bowel wall occur in coeliacs?
Hypertrophy of crypts
Atrophy of villi
Why does malabsorption occur in coeliacs disease?
There is atrophy of villi, therefore the surface area for absorption is greatly reduced
What investigations should be done if a diagnosis of coeliacs is suspected?
Anti-endomysial antibody / anti-tTg antibody
Endoscopy and duodenal biopsy
Why is the proximal small bowel most affected in coeliacs disease?
The concentration of gluten is highest here
What are some of the common causes of abdominal artery ischaemia/occlusion?
Atherosclerosis Embolism Dissection External compression by mass legions Fibromuscular dysplasia
What are some of the common sites of occlusion in abdominal artery ischaemia/occlusion?
Superior mesenteric
Celiac arteries
Bifurcation of the aorta
What are some of the signs and symptoms of acute abdominal artery occlusion?
Severe, diffuse abdominal pain
In renal artery: sudden onset flank pain and haematuria
What are some of the signs and symptoms of chronic bowel ischaemia?
Often asymptomatic - unless both superior mesenteric and celiac arteries occluded Intestinal angina Abdominal bruit Nausea Vomiting Constipation Dark stools
In which condition might sublingual GTN be useful?
Bowel ischaemia for “intestinal angina”
How is the diagnosis of chronic abdominary artery ischaemia made?
Based mainly on clinical findings
Angiography
What are some causes of small bowel obstruction?
Adhesions Hernaie Tumours Crohn's Volvulus Gallstone ileus Intersusception Ischaemia TB Hair ball
What types of hernia are there?
Inguinal Femoral Umbilical/paraumbilical Epigastric Incisional
How might a small bowel obstruction present?
Colicky abdominal pain (often felt around umbilicus)
Vomiting - often provides pain relief
Abdominal distension
High pitched “tinking” bowel sounds
What signs may be present in strangulation (complete bowel obstruction)?
Shock
Oliguria (low urine output)
No flatulence
Tender abdomen
What investigations should be done if diagnosis of small bowel obstruction suspected?
History
Examination
Plain AXR
Which sign on a supine AXR is the sign of a gallstone ileus?
Gas in biliary tree
How might you differentiate between loops of small and large bowel on AXR?
Small bowel loops are the width of the lumen
Large bowel are not complete width
How would you manage a small bowel obstruction?
NG tube for aspiration Nil by mouth Hydration Electrolyte restoration If unsettled - laparotamy
In which patients might Meckel’s diverticulum present symptomatically?
Children
What are some of the symptoms of Meckel’s diverticulum?
Rectal bleeding
Obstruction
Perforation
How is the diagnosis of Meckel’s diverticulum made?
Technicium Tc 99M scan - detects ectopic gastric mucosa
Approximately 50% of symptomatic Meckel’s diverticula have ectopic gastric or pancreatic cells contained within them
What is Meckel’s diverticulum an embryological remnant of?
A vestigial remnant of the omphalomesenteric duct
What is the rule of 2’s of Meckel’s diverticulum?
Affects 2% of the population
Is approximately 2ft from the ileocaecal valve
Is a small pouch of roughly 2cm
2 types of common ectopic tissue (gastric and pancreatic)
Why might small bowel ischaemia be confused with pancreatitis in investigation results?
Increased amylase
