Small Intestinal Disorders and Investigation Flashcards
What is the normal range of size for a males large bowel and how much of this is required for digestive function?
6m 2.5-4.5 by age 11
1.5m for digestive purposes
What are the functions of the small intestine?
Digestion
Absorption
Endocrine and neuronal control functions - Controlling flow of material from the stomach to the colon
What is the purpose of the barrier function?
To maintain a barrier against pathogens
How does the small intestine maintain this barrier against pathogens?
Immune sampling
Monitoring pathogen presence
Undergoes bacteria translocation
Immune system will decide what to kill and what to leave
How does the small intestine maintain a low bacterial environment?
Toxic environment with bile and digestive enzymes
Motility disrupts efficiency
How long does amylase last until it is rendered useless by acid?
20seconds
Why would it be bad if starch was broken the whole way down straight away?
Water would flood into the gut and the body wouldn’t be able to control the fluid shift
What small intestine disorders are there? (8)
Bleeding Coeliac disease Crohn's disease Infections Intestinal cancer Intestinal obstruction Irritable bowel syndrome (IBS) Ulcers, such as a peptic ulcer
What are the symptoms of small intestinal disorders?
Weight loss - Important
Increased appetite
Steatorrhoea
What are the signs of small intestinal disorders?
Weight loss
Low or falling BMI
What is steatorrhoea and how does it present?
Fat in the stools
Stools are foul smelling, pale, float and may be oily
What is steatorrhoea a result of?
Fat malabsorption
What are the signs of malabsorption?
Vitamin B12 and Folate are normally knocked off
What are the signs of Vitamin A deficiency?
Night blindness
Falls may be the first signal
What are the signs of Calcium, Magnesium and Vitamin D deficiency?
Tetany (Ca def)
Osteomalcia (D of Ca def)
What is tetany?
Intermittent muscular spasms caused by parathyroid gland malfunction
What is osteomalacia?
Softening of the bones
What is the sign for Vitamin K deficiency?
Raised PTR
Iron - Anaemia
What is the sign for Vitamin B complex deficiency?
Thiamine leading to memory loss and dementia
Niacin leading to dermatitis and unexplained HF
What goes up when people are ill and it must be replaced?
Thiamine demand
What is the sign of Vitamin C deficiency?
Scurvy - Swollen bleeding gums and opening of healed wounds
What are the non-specific signs of Coeliac and Crohns disease?
Clubbing
Aphtuous Ulcerationn
What is the for systemic sclerosis?
Sclerderma
What is dermatitis herpetiformis?
Cutaneous manifestation of coeliac disease that blisters and becomes very itchy
Where is dermatitis herpetiformis found and what does it deposit in the skin?
Scalp, shoulder, elbows and knees
IgA
What investigations are done for small bowel disorders?
Small bowel biopsy/study White cell scan CT & MRI enteropgraphy Capsule enterography Bacterial overgrowth - Hydrogen breath test Culture a duodenal or jejunal aspirate
How does the hydrogen breath test work?
Patient swallows glucose
Fermented by bacteria straight away and patient will exhale Hydrogen
What is the best for a suspicion of coeliac disease?
IgA antibody
How come is coeliac disease in the UK?
1:111
What causes the reaction in coeliac’s?
Sensitivity to gliadin fraction of gluten
What does the response to gliadin cause and what will those with coeliac disease have?
Inflammatory response causing partial or subtotal villous atrophy
Increased intra-epithelial lymphocytes
What tests will give a diagnosis of coeliac disease?
Distal duodenal biopsy
Serology
What is the treatment for those with coeliac disease?
Withdraw gluten from the diet
What complications can occur in the small intestine?
Refractory coeliac disease Small bowel lymphoma Oesophageal carcinoma Colon cancer Small bowel adenocarcinoma
What are the causes of malabsorption? (7)
Inflammation Infection Whipples disease Infiltration Impaired motility Iatrogenic Pancreatic
What causes inflammation in the small intestine resulting in malabsorption?
Coeliac disease
Crohns disease
What causes infection in the small intestine resulting in malabsorption?
Tropical spure - Folate deficiency
HIV
Giardia Lamblia - Parasite
What causes Whipples disease in the small intestine resulting in malabsorption?
Skin, brain, joints and cardiac effects
Weight loss & abdominal pain
What causes infiltration in the small intestine resulting in malabsorption?
Amyloid
What causes impaired motility in the small intestine resulting in malabsorption?
Systemic sclerosis
Diabetes
Pseudo obstruction
What is iatrogenic in the small intestine resulting in malabsorption?
Gastric surgery
Short bowel syndrome
Radiation
What pancreatic diseases result in malabsorption?
Chronic pancreatitis
Cystic Fibrosis
What is diverticula?
Disease of the small bowel where pouches of mucosa protrude through the colonic muscular wall via weakened areas near blood vessels to form diverticula
