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gastrointestinal pathology > Small Intestinal Disorders > Flashcards

Small Intestinal Disorders Flashcards

1
Q

Symptoms of malabsorption

A 
Weight loss
Increased apetite
Steatorrhoea 
Diarrhoea
Bloating 
Fatigue
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2
Q

Definition of steatorrhoea

A

Fatty stool

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3
Q

Features of steatorrhoea

A 
HIGH fat content in stool 
Stool less dense so floats
Pale
Foul smelling 
May leave oily mark
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4
Q

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

A

Coeliac disease

Crohn’s disease

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5
Q

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

A

Coeliac disease

Crohn’s disease

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6
Q

What is dermatitis herpetiformis?

A

Cutaneous manifestation of coeliac disease

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7
Q

Presentation of dermatitis herpetiformis

A

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

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8
Q

Where do you get dermatitis herpetiformis?

A

Scalp
Shoulders
Elbows
Knees

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9
Q

Pathology of dermatitis herpetiformis

A

IgA deposit in the skin

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10
Q

Investigations for malabsorption

A 
Small bowel biopsy - endoscopy 
Barium study of the small bowel 
White cell scan 
CT scan 
MRI enterography 
Capsule enterography
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11
Q

What can be used in diagnosis of coeliac disease?

A

HLA status

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12
Q

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

A

HLA dq2 or dq8

30%

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13
Q

What happens to the villi in coeliac disease?

A

Villous atrophy

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14
Q

What % of coeliac in the population are known about?

A

33%

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15
Q

What do coeliacs have a sensitivity to?

A

Gliadin fraction of gluten

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16
Q

What is gluten found in?

A

Wheat
Rye
Barley

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17
Q

Pathology of coeliac disease

A

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

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18
Q

Gold standard diagnostic test for coeliac disease

A

Distal duodenal biopsy

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19
Q

Investigations for coeliac disease

A

Distal duodenal biopsy

Serology

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20
Q

What serology is used in the investigation of coeliac disease?

A 
Anti endomysial IgA
Anti tissue transglutaminase 
Anti gliadin (children, not adults)
21
Q

Treatment of coeliac disease

A

Withdraw gluten

22
Q

Assosiated conditions to coeliac disease

A 
Dermatitis herpetiformis 
IDDM
Autoimmune thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Autoimmune gastritis 
Sjrogen syndrome 
IgA deficiency 
Downs syndrome
T1DM
23
Q

Complications of coeliac disease

A 
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
24
Q

Causes of malabsorption

A 
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
25
Q

Treatment for giardia lamblia

A

Metronidazole

26
Q

Who gets whipples disease?

A

Middle aged men

27
Q

Presentation of whipples disease

A 
Skin, brain, joints and cardiac effects
Weight loss
Malabsorption 
Abdominal pain 
PAS material in villi
28
Q

Causative organism of whipples disease

A

Tropheryma whippelli

29
Q

Functions of the small intestine

A

Digestion
Absorption
Endocrine and neuronal control functions
Barrier functions

30
Q

Average length of the small bowel

A

250 - 450 cm

31
Q

How does the small bowel have a large surface area?

A

Villous architecture

Constant turnover of cells in crypts and villi

32
Q

How does digestion work?

A

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

33
Q

What are proteins broken down into?

A

Oligopeptides

Amino acids

34
Q

What pH does amylase operate at?

A

Ph7

Goes into pH 1 in the stomach

35
Q

What enzyme helps the digestion of fat?

A

Pancreatic lipase

36
Q

What enzyme helps the digestion of carbohydrates?

A

Pancreatic amylase

37
Q

Iron deficiency; men vs women

A

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

38
Q

What immunisation should coeliacs receive and why is this?

A

Pneumococcal vaccine - boosters every 5 years

BECAUSE potential to develop overwhelming pneumococcal sepsis due to Hyposplenism

39
Q

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

A

Coeliac disease

40
Q

What deficiencies does coeliac disease result in?

A

Folate
Iron
Vit B12

41
Q

What skin feature is present in pernicious anaemia and why?

A

Lemon tinge to the skin

Combination of pallor (due to the anaemia) and mild jaundice (due to the haemolysis)

42
Q

What is the most common symptom of CD in children?

A

Abdominal pain

43
Q

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

A

PPIs

44
Q

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

A

Vitamin C

45
Q

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?

A

6 weeks

46
Q

Risk factors for small bowel bacterial overgrowth

A

DM
Scleroderma
Neonates with congenital GI abnormalities

47
Q

What may features of small bowel bacterial overgrowth overlap with?

A

IBS

48
Q

Investigations of small bowel bacterial overgrowth

A

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

49
Q

Management of small bowel bacterial overgrowth

A

Correction of underlying disorder

Ax therapy; rifampicin 1st line

gastrointestinal pathology (26 decks)

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