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Gastrointestinal > Small Intestinal Disorders and Investiation > Flashcards

Small Intestinal Disorders and Investiation Flashcards

1
Q

What are the functions of the small intestine?

A

Digestion

the breaking of food into its components

Absorption

The passage of nutrients into the body

Endocrine and neuronal control functions

Controlling the flow of material from the stomach to the colon

Barrier functions

Regulating what stays in and gets out.

Maintaining a barrier against pathogens

Immune sampling

Monitoring the presence of pathogens

Translocation of Bacteria

Gut Associated Lymphoid Tissue (GALT)

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2
Q

What contributes to the low bacterial population in the small intestine?

A

Toxic environment

Digestive enzymes

Bile salts

Presence of IgA etc

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3
Q

How are proteins broken down?

A
  • Breakdown to oligopeptides & amino acids
  • Trypsin, chymotrypsin
  • Final hydrolysis and absorption at brush border
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4
Q

How are fats digested?

A

Pancreatic lipase

Absorption of glycerol and free fatty acids

via lacteal and lymphatic system

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5
Q

How are carbohydrates digested?

A

Pancreatic amylase

Breakdown to disaccharides

Final digestion by brush border disaccharidase

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6
Q

What are symptoms of small intestine malabsorption syndrome?

A
  • Weight Loss
  • Increased appetite
  • Diarrhoea - Usually watery - Sometimes steatorrhoea
  • Bloating
  • Fatigue
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7
Q

What is steatorrhoea?

A

Fat malabsorption

High fat content in stool

Stool less dense and floats

Pale

Foul smelling

May leave an oily mark or oil droplets

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8
Q

What are signs of malabsorption?

A

Signs of weight loss

Low or falling BMI

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9
Q

What are signs of Ca2+, Mg2+ and Vitamin D deficiency?

A

Tetany and osteomalacia

Tetany: a condition marked by intermittent muscular spasms, caused by malfunction of the parathyroid glands and a consequent deficiency of calcium.

Osteomalacia: softening of the bones, typically through a deficiency of vitamin D or calcium.

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10
Q

What is the specific sign of vitamin A deficiency?

A

Night blindness

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11
Q

What is the specific sign for vitamin K deficiency?

A

Raised PTR (prothrombin time)

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12
Q

What is the specific sign of vitamin B complex deficiency?

A

Thiamine: (often on refeeding)

Memory, dementia

Wernicke-Korsakoff syndrome - Wernicke encephalopathy and Korsakoff syndrome are different conditions that often occur together. Both are due to brain damage caused by a lack of vitamin B1 (thiamine)

Niacin:

Dermatitis, unexplained heart failure

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13
Q

What is the specific sign for vitamin C deficiency?

A

Scurvy

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14
Q

What are signs of coeliac disease and Crohns?

A

Clubbing and Apthous ulceration

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15
Q

What can scleroderma be a sign for?

A

Systemic sclerosis

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16
Q

What is the cutaneous manifestation of coeliac disease?

A

Dermatitis herpetiformis:

Blistering

Intensely itchy

Scalp, shoulders, elbows, knees

IgA deposit in skin

17
Q

What are the tests of structure of the small intestine?

A

Small bowel biopsy

Endoscopy

Small Bowel Study

Barium

CT Scan

MRI enterography

Capsule enterography

White Cell Scan

18
Q

What are the tests for coeliac disease?

A

IgA tests (althogh a significant number of people don’t make IgA)

IgA anti-endomysial antibodies are detected by immunofluorescence.

IgG antibodies must be analysed in patients with IgA deficiency

Tissue transglutaminase is now recognised as the autoantigen for anti-endomysial antibodies often used in serological diagnosis

Distal duodenal biopsy: Gold standard, villous atrophy, sometimes the villi may appear normal but there are excess numbers of intraepithelial lymphocytes present.

HLA status

97 % of coeliacs are either HLA DQ2 or DQ8

But so are 30% of the population.

Useful to exclude but not to confirm coeliac disease

19
Q

What is the prevalence of coeliacs disease?

A

1 in 200 although 50% of these patients will be asymptomatic

20
Q

What part of gluten are coeliacs allergic to?

A

Gliadin

Found in Wheat, Rye, Barley

Absent from rice and maize

Not found in oats but most oat products are contaminated with wheat

21
Q

What is the pathology of coeliacs disease?

A

Produces an inflammatory response

Thought to be via tissue Transglutaminase

Partial or subtotal villous atrophy

Increased intra-epithelial lymphocytes

Gold standard diagnosis is still a distal duodenal biopsy

22
Q

What is diagnosis of coeliacs disease?

A

Distal duodenal biopsy

Serology

Anti endomysial IgA

Anti Tissue transglutaminase

Both 95% specific and sensitive

[Anti gliadin may help in children but not diagnostic in adults]

23
Q

What is treatment for coeliacs disease?

A

Withdraw Gluten

24
Q

What are the conditions with coeliacs disease?

A

Dermatitis herpetiformis

IDDM (insulin dependant diabetes mellitus)

Autoimmune thyroid disease

Autoimmune hepatitis

Primary Biliary cirrhosis

Autoimmune gastritis

Sjogren syndrome

IgA deficiency

Downs Syndrome

25
Q

What are complicatinos associated with coeliacs disease?

A

Refractory Coeliac Disease

Small bowel lymphoma (T-Cell)

Oesophageal carcinoma (squamous)

Colon Cancer

Small bowel adenocarcinoma

26
Q

What are the inflammatory and infectious causes of malabsorption?

A

Inflammation

  • Coeliac disease
  • Crohns

Infection

  • Tropical sprue

Folate deficiency

Responds to antibiotics

  • HIV
  • Giardia Lamblia
27
Q

What is tropical sprue?

A

Chronic progressive malabsorption

Patient is in or from the tropicsassociated with abnormalities of small intestinal structure or function.

Occurs mainly in west indies and in asia including southern india. Infective agent may be involved, no single bacterium has been isolated - condition often begins with acute diarrhoel illness. Small bowel bacterial overgrowth with E.Coli, enterobacter and klebsiella is frequently seen.

28
Q

What are the fewatures of Giardia Lamblia?

A

Unicellular parasite

Contaminated water

Responds to Metronidazole

Hypogammaglobulinaemia

29
Q

Several other causes of malabsorption

A

Whipples disease

  • Middle aged men
  • Skin, brain, joints and cardiac effects
  • Weight loss
  • Malabsorption
  • Abdominal pain
  • PAS material in villi

Tropheryma whippelii - Causative organism

Infiltration

  • Amyloid

Impaired motility

  • Systemic sclerosis
  • Diabetes
  • Pseudo obstruction

Iatrogenic

  • Gastric surgery
  • Short bowel syndrome
  • Radiation

Pancreatic

  • Chronic pancreatitis
  • Cystic fibrosis
30
Q

When can bacterial overgrowth occur?

A

In any condition that affects motility, gut structure and immunity

H2 Breath test

BUT: very unreliable.

If in doubt give a course of rotating antibiotics.

31
Q
A

Gastrointestinal (38 decks)

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