Small Intestinal Disorders Flashcards by Annie Caldwell

Symptoms of malabsorption

Weight loss
Increased apetite
Steatorrhoea 
Diarrhoea
Bloating 
Fatigue

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Definition of steatorrhoea

Fatty stool

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Features of steatorrhoea

HIGH fat content in stool 
Stool less dense so floats
Pale
Foul smelling 
May leave oily mark

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What can clubbing be a non specific sign of (in small bowel disorders)?

Coeliac disease

Crohn’s disease

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What can aphthous ulceration be a non specific sign of (in small bowel disorders)?

Coeliac disease

Crohn’s disease

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What is dermatitis herpetiformis?

Cutaneous manifestation of coeliac disease

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Presentation of dermatitis herpetiformis

Blistering
Intensely itchy
Patients usually scratch them off before you see them as they are intensly itchy

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Where do you get dermatitis herpetiformis?

Scalp
Shoulders
Elbows
Knees

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Pathology of dermatitis herpetiformis

IgA deposit in the skin

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Investigations for malabsorption

Small bowel biopsy - endoscopy 
Barium study of the small bowel 
White cell scan 
CT scan 
MRI enterography 
Capsule enterography

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What can be used in diagnosis of coeliac disease?

HLA status

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What HLA types do 97% of coeliacs carry? What % of normal population carry them?

HLA dq2 or dq8

30%

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What happens to the villi in coeliac disease?

Villous atrophy

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What % of coeliac in the population are known about?

33%

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What do coeliacs have a sensitivity to?

Gliadin fraction of gluten

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What is gluten found in?

Wheat
Rye
Barley

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Pathology of coeliac disease

Inflammatory response
Partial or subtotal villous atrophy
Increased intra-epithelial lymphocytes

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Gold standard diagnostic test for coeliac disease

Distal duodenal biopsy

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Investigations for coeliac disease

Distal duodenal biopsy

Serology

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What serology is used in the investigation of coeliac disease?

Anti endomysial IgA
Anti tissue transglutaminase 
Anti gliadin (children, not adults)

Treatment of coeliac disease

Withdraw gluten

Assosiated conditions to coeliac disease

Dermatitis herpetiformis 
IDDM
Autoimmune thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Autoimmune gastritis 
Sjrogen syndrome 
IgA deficiency 
Downs syndrome
T1DM

Complications of coeliac disease

Refractory coeliac disease 
Small bowel lymphoma
Oesophageal carcinoma
Colon carcinoma
Small bowel adenocarcinoma 
Osteoporosis
Anaemia; iron, folate and vit B12 deficiency 
Hyposplenism 
Lactose intolerance
Subfertility / unfavourable pregnancy outcomes

Causes of malabsorption

Crohn's disease
Coeliac disease 
Tropic spruae 
HIV
Giardia Lamblia 
Whipples disease
Infiltration - amyloid 
Impaired motility
- systemic sclerosis
- Diabetes
- pseudo-obstruction 
Gastric surgery 
Short bowel syndrome
Radiation 
Chronic pancreatitis
Cystic fibrosis

Treatment for giardia lamblia

Metronidazole

Who gets whipples disease?

Middle aged men

Presentation of whipples disease

``` Skin, brain, joints and cardiac effects Weight loss Malabsorption Abdominal pain PAS material in villi ```

Causative organism of whipples disease

Tropheryma whippelli

Functions of the small intestine

Digestion Absorption Endocrine and neuronal control functions Barrier functions

Average length of the small bowel

250 - 450 cm

How does the small bowel have a large surface area?

Villous architecture | Constant turnover of cells in crypts and villi

How does digestion work?

Salivary amylase in mouth Pepsin Controlled breakdown to avoid osmotic shifts Fat centres in the duodenum will slow down digestion as the stomach knowns that fat takes longer to digest. Therefore stomach emptying is very controlled

What are proteins broken down into?

Oligopeptides | Amino acids

What pH does amylase operate at?

Ph7 | Goes into pH 1 in the stomach

What enzyme helps the digestion of fat?

Pancreatic lipase

What enzyme helps the digestion of carbohydrates?

Pancreatic amylase

Iron deficiency; men vs women

A man with a normal diet should not be iron deficient | A women with normal diet can be iron deficiency if they get heavy periods

What immunisation should coeliacs receive and why is this?

Pneumococcal vaccine - boosters every 5 years | BECAUSE potential to develop overwhelming pneumococcal sepsis due to Hyposplenism

Patients with T1DM or autoimmune thyroid disease should be screened for what condition at diagnosis?

Coeliac disease

What deficiencies does coeliac disease result in?

Folate Iron Vit B12

What skin feature is present in pernicious anaemia and why?

Lemon tinge to the skin | Combination of pallor (due to the anaemia) and mild jaundice (due to the haemolysis)

What is the most common symptom of CD in children?

Abdominal pain

What medications (apart from the 4Cs) are a risk factor for C diff?

PPIs

Easy bruising and bleeding gums would point towards a deficiency of what?

Vitamin C

How long before getting tested for coeliac disease do you need to reintroduce gluten into the diet if the patient had done their own gluten exclusion trial?

6 weeks

Risk factors for small bowel bacterial overgrowth

DM Scleroderma Neonates with congenital GI abnormalities

What may features of small bowel bacterial overgrowth overlap with?

IBS

Investigations of small bowel bacterial overgrowth

Hydrogen breath test Small bowel aspiration and culture (less often used) May be given course of Ax to try as diagnostic trial

Management of small bowel bacterial overgrowth

Correction of underlying disorder | Ax therapy; rifampicin 1st line