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Alimentary System > Small intestinal disorders and investigations > Flashcards

Small intestinal disorders and investigations Flashcards

1
Q

What is digestion?

A

Breaking down of food into its components

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2
Q

What is absorption?

A

Passage of nutrients into the body

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3
Q

what are barrier functions?

A

Regulating what stays in and gets out

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4
Q

what are endocrine and neuronal control functions of the small intestine?

A

Controlling the flow of material from the stomach to the colon
Motility

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5
Q

What are the functions of the small intestine?

A

Digestion

Absorption

Endocrine and neuronal control (flow of material from stomach to colon)

Barrier functions

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6
Q

When is the full length of the small intestine reached?

A

Usually by age 11

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7
Q

what are the functions of digestion?

A

Decontaminates dirty food
Requires a lot of fluid
Controlled hydrolysis to avoid fluid shifts
Sophisticated control of motility
Absorption against gradients
Onward processing in the liver

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8
Q

where does digestion commence?

A

in the stomach

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9
Q
A
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10
Q

what causes digestion in the stomach?

A

Salivary amylase
Pepsin
Controlled breakdown to avoid osmotic shifts

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11
Q

how are proteins digested?

A

Broken down to oligopeptides & amino acids
Trypsin, chymotrypsin
Final hydrolysis and absorption at brush border

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12
Q

where does final hydrolysis and absorption of proteins occur?

A

brush border

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13
Q

how is fat digested?

A

Pancreatic lipase
Absorption of glycerol and free fatty acids
via lacteal and lymphatic system

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14
Q

how are carbohydrates digested?

A

Pancreatic amylase
Breakdown to disaccharides
Final digestion by brush border disaccharidase

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15
Q

What allows the small intestine to have such as large surface area?

A

Villous architecture

Constant turnover of cells in crypts and villi

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16
Q

Why does the small intestine have a low bacterial population?

A

Toxic environment due to digestive enzymes, bile salts and IgA

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17
Q

What does maintaining control of digestion require?

A

Lots of fluid

Controlled hydroplysis to avoid fluid shifts

Sophisticated control of motility

Absorption against gradients

Onwards processing in the liver

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18
Q

What enzymes are in the stomach for digestion?

A

Salivary amylase

Pepsin

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19
Q

Why must digestion in the stomach be controlled?

A

Avoid osmotic shifts

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20
Q

What are proteins broken down into?

A

Oligopeotides and amino acids

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21
Q

What enzymes control the breakdown of protein?

A
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22
Q

are there many small bowel investigations that are tests of structure?

A

many and various

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23
Q

are there many small bowel investigations that are tests of function?

A

very few

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24
Q

what are the tests of structure available for the small intestine?

A

Small bowel biopsy
Endoscopy

CT Scan

MRI enterography

Capsule enterography

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25
Q

what is capsule enterography?

A

Capsule endoscopy is a procedure that uses a tiny wireless camera to take pictures of your digestive tract. A capsule endoscopy camera sits inside a vitamin-size capsule you swallow. As the capsule travels through your digestive tract, the camera takes thousands of pictures that are transmitted to a recorder you wear on a belt around your waist.

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26
Q

what are other assorted tests of the small intestine?

A

Bacterial overgrowth
H2 Breath test
Lactulose or glucose substrate
Culture a duodenal or jejunal aspirate

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27
Q

What enzymes control the breakdown of protein?

A

Trypsin and chymotrypsin

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28
Q

What enzyme controls the breakdown of fat?

A

pancreatic lipase

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29
Q

What is fat broken down into?

A

Glycerol and free fatty acids

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30
Q

What enzyme controls carbohydrate breakdown?

A

Pancreatic amylase

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31
Q

What does pancreatic amylase break carbohydrates down into?

A

Disaccharides

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32
Q

What does the final digestion of carbohydrates?

A

Brush border disaccharidase

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33
Q

What are symptoms of small intestine disorders?

A

Weight loss

Increased appetite

Diarrhoea

Sometimes steatorrhoea

Bloating

Fatigue

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34
Q

What is steatohoea caused by?

A

Fat malabsorption

35
Q

What is poo like for someone who has steatorrhoea?

A

High fat content

Stool less dense and floats

Pale

Foul smeeling

May leave an oily mark or oil droplets

36
Q

What are signs of small intestinal disorders?

A

Signs of weight loss such as low or falling BMI

37
Q

What are some examples of possible vitamin/mineral deficiencies?

A

Iron

B12

Ca2+, Mg2+

D

B9 (folate)

A

K

B complex

C

38
Q

What is a sign of vitamin A deficiency?

A

Night blindness

39
Q

What is a sign of vitamin K deficiency?

A

Raised PTR

40
Q

What are signs of thiamine deficiency?

A

Memory, dementia

41
Q

What are signs of niacin deficiency?

A

Dermatitis, unexplained heart failure

42
Q

What is a sign of vitamin C deficiency?

A

scurvy

43
Q

What is clubbing a sign of?

A

Coeliac disease

Crohn’s disease

44
Q

What is scleroderma a sign of?

A

Systemic sclerosis

45
Q

What is aphthous ulceration a sign of?

A

Coeliac disease

Crohn’s disease

46
Q

What is dermatitis herpetiformis?

A

Cutaneous manifestation of coeliac disease:

blistering

intensely itchy

scalp, shoulders, elbows, knees

IgA deposits on skin

47
Q

how common is coeliacs disease?

A

1:111 in UK on screening data
1:300 clinical diagnosis

48
Q

what are tests done for coeliacs disease?

A

Serology
IgA/IgG tests - IgA more reliable than IgG, only if you make IgA a significant amount of people dont
ALWAYs check plasma IgA aswell

49
Q

how common is selective IgA deficiency?

A

Selective IgA deficiency is relatively common, about 0.1 to 1% of population
But 2 to 3% of coeliacs

50
Q

Are IgA or IgG tests more reliable?

A

IgA

51
Q

Who often has selective IgA deficiency?

A

Coeliacs (3%)

52
Q

What are confirmational tests for coeliac disease?

A

Distal duodenal biopsy (looking for villous atrophy and HLA status)

53
Q

what are the different types of villous atrophy?

A

Partial
Subtotal
Total

54
Q

What is coeliac disease?

A

Autoimmune disease where the small intestine becomes inflammed

55
Q

What is gliadin?

A

Class of proteins present in wheat, rye and barley

56
Q

What is gliadin a component of?

A

gluten

57
Q

What is the pathology of gliadin in people with Coeliac disease?

A

Produces an inflammatory response

Partial or subtotal villous atrophy

Increased intra-epithelial lymphocytes

58
Q

What is done to diagnose people allergic to gliadin

A

Distal duodenal biopsy

Serology (anti endomysial IgA, anti-tissue transglutaminase)

59
Q

is gliadin in rice, maize or oats?

A

no

60
Q

Though what tissue does gliadin produce an inflammatory response through?

A

Thought to be transglutaminase

61
Q

what are 97% of coeliacs for their HLA status?

A

either HLA DQ2 or DQ8

62
Q

What is the treatment for people allergic to gliadin?

A

Withdraw gluten

Refer to state registered dietitian

63
Q

What are some associated conditions with gliadin allergy?

A

Dermatitis herpetiformis
IDDM
Autoimmune thyroid disease
Autoimmune hepatitis
Primary Biliary Cholangitis
Autoimmune gastritis
Sjogren’s syndrome
IgA deficiency
Down’s Syndrome

64
Q

What are some complications of gliadin allergy?

A

Refractory coeliac disease

Small bowel lymphoma

Oesophageal carcinoma

Colon cancer

Small bowel adenocarcinoma

65
Q

What are different categories of causes of malabsorption?

A

Inflammation

Infection

Infiltration

Impaired motility

Iatrogenic

Pancreatic

66
Q

What are some diseases that cause malabsorption through inflammation?

A

Coeliac disease

Crohn’s disease

67
Q

What are some infections that can cause malabsorption?

A

Tropical sprue

HIV

Giardia lamblia

Whipple’s disease

68
Q

what is giardia lamblia?

A

Unicellular parasite
Contaminated water
Responds to Metronidazole
Hypogammaglobulinaemia

69
Q

What is an infiltrative cause of malabsorption?

A

amyloid

70
Q

What are diseases that can cause impaired motility leading to malabsorption?

A

Systemic sclerosis
Diabetes
Pseudo obstruction

71
Q

What are some iatrogenic causes of malabsorption?

A

Gastric surgery

Short bowel syndrome

Radiation

72
Q

What are some pancreatic causes of malabsorption?

A

Chronic pancreatitis

Cystic fibrosis

73
Q

who does whipples disease most commonly affect?

A

middle aged men

74
Q

what does whipples disease affect?

A

skin, brain,joints, cardiac effects

75
Q

what are symptoms of whipples disease?

A

Weight loss
Malabsorption
Abdominal pain

76
Q

what is the causative organism of whipples disease?

A

Tropheryma whippelii is the causative organism

77
Q

Small bowel overgrowth can occur in any condition that affects what?

A

Motility

Gut structure

Immunity

78
Q

What is small bowel overgrowth diagnosed by?

A

H2 breath test

79
Q

What is the treatment for small bowel overgrowth?

A

Rotating antibiotics

80
Q

what are the rotating antibiotics examples, how long should they each be taken for?

A

Metronidazole
Tetracycline
Amoxicillin

each for two weeks

81
Q

what should be taken alongside rotating antibiotics?

A

Vitamin and nutritional supplements

82
Q

77 year old man
Losing weight
Steatorrhoea
Recent minor fall with fractured neck of femur
Radiologist notes features of osteomalacia

what is this man suffering from?

A

Tests confirm
Fat malabsorption
Bacterial overgrowth

Small bowel study
Multiple jejunal diverticula

83
Q

23 year old student
Tired
? Losing a little weight
Variable stool
Bloating
PMH
Irritable Bowel Syndrome

On Examination
Thin
BMI 20 kg / m2

what is this student suffering from?

A

Hb 108
MCV 79
A microcytic anaemia
Alb 34
Very slightly reduced
Corrected Ca2+ 2.05 mmol/l

? Coeliac disease

Anti tissue transglutaminase (Anti-TTG) IgA negative
[Anti endomysial antibody neg]
Plasma IgA 0.1

Alimentary System (44 decks)

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