Small Intestinal Disease Flashcards
What are the barrier functions of the small intestine?
Immune sampling
Monitoring the presence of pathogens
Translocation of bacteria
GALT
What is GALT?
Gut associated lymphoid tissue
What elements cause the lumen of the small intestine to be toxic?
Digestive enzymes
Bile salts
IgA presence
How are proteins broken down in digestion?
Breakdown to oligopeptides and AAs
Trypsin, chymotrypsin
Hydrolysis at brush border
What are the symptoms of small bowel disorder?
Weight loss Increased appetite Diarrhoea Bloating Fatigue
How does diarrhoea present in small bowel disorder?
Watery
Sometimes steatorrhoea
What causes steatorrhoea?
Fat malabsorption
High fat content stool
What are the signs of small bowel disorder?
Weight loss
Falling/low BMI
What are the signs of Ca, Mg and Vit D deficiency?
Tetany
Osteomalacia
What is the sign of vitamin A deficiency?
Night blindness
What is the sign of vitamin K deficiency?
Raised Proton transfer reaction
What is the sign of thiamine (B1) deficiency?
Memory loss
Dementia
What is the sign of Niacin (B3) deficiency?
Dermatitis
Unexplained Heart Failure
What is the sign of vitamin C deficiency?
Scurvy
Scleroderma is suggestive of what?
Systemic sclerosis
Aphthous ulceration is suggestive of what?
(mouth ulcer)
Coeliac
Crohns
What is dermatitis herpetiformis?
Cutaneous manifestation of Coeliac disease
How does dermatitis herpetiformis present?
Itchy, blistering IgA deposits in skin
Scalp, shoulders, elbows, knees
What investigations can be used to test the structure of the small bowel?
Biopsy
Meal study
CT Scan
MRI/capsule enterography
How can bacterial overgrowth of the small bowel be tested?
H2 breath test
Duodenal/jejunal aspirate culture
How is a Bacterial overgrowth breath test performed?
Lactulose or glucose substrate peaking in breath just after consumption
Why is Coeliac serology not 100% useful in a coeliac diagnosis?
Whilst IgA is more useful than IgG, not all patients actually make IgA (higher in Coeliacs patients)
What must also be tested in combination with IgA TTG?
Plasma IgA levels
How is a Coeliac disease diagnosis confirmed?
Positive serology
HLA status
Distal duodenal biopsy
What Coeliac-positive result is observed in a duodenal biopsy?
Villous atrophy
partial, subtotal or total
Coeliac-positive patients will likely present with which HLA haplotypes?
DQ2 or DQ8
Coeliac disease patients are allergic to which fraction of gluten?
Gliadin
Why must you be careful of when diagnosing Coeliac disease?
It can mask other diseases
What factors are looked for in coeliac serology?
Anti endomysial IgA
Anti Tissue transglutaminease
How is Coeliac’s disease treated?
Stop eating Gluten
Refer to dietician
What is refractory coeliac disease?
Coeliac disease symptoms in patients on a gluten free diet (common in later age)
What are common complications of Coeliac’s disease?
Refractory Coeliacs disease
Cancers
Which inflammatory bowel diseases cause malabsorption?
Coeliac disease
Crohns disease
Which infective bowel disease causes malabsorption?
Tropical sprue
HIV
Gardia lamblia
What does tropical sprue cause?
Folate (B9) deficiency
What is Gardia lamblia?
Waterborne Unicellular parasite
Gardia lamblia is more common in patients suffering from what?
Hypogammaglobulinaemia
What is the treatment for Gardia lamblia infection?
Metronidazole
What does Gardia lamblia infection cause?
Gardiasis
Whipple’s disease is caused by what?
Tropheryma whippelii
What are the symptoms of Whipples disease?
Weight loss
Malabsorption
Abdominal pain
Skin, brain, joint, heart effects
Whipple’s disease typically effects whom?
Middle aged men
Small bowel overgrowth can occur in conditions that effect what?
Motility
Gut structure
Immunity
What is the main test used in small bowel overgrowth?
H2 breath test (unreliable)
What treatment is given in small bowel overgrowth?
Rotating antibiotics for 2 weeks: Metronidazole Tetracycline Amoxycillin Vit/nutritional supplements
