Small Intestinal Disorders and Investigation

Question 1

What is the normal range of size for a males large bowel and how much of this is required for digestive function?

Answer 1

6m 2.5-4.5 by age 11

1.5m for digestive purposes

Question 2

What are the functions of the small intestine?

Answer 2

Digestion
Absorption
Endocrine and neuronal control functions - Controlling flow of material from the stomach to the colon

Question 3

What is the purpose of the barrier function?

Answer 3

To maintain a barrier against pathogens

Question 4

How does the small intestine maintain this barrier against pathogens?

Answer 4

Immune sampling
Monitoring pathogen presence
Undergoes bacteria translocation
Immune system will decide what to kill and what to leave

Question 5

How does the small intestine maintain a low bacterial environment?

Answer 5

Toxic environment with bile and digestive enzymes

Motility disrupts efficiency

Question 6

How long does amylase last until it is rendered useless by acid?

Answer 6

20seconds

Question 7

Why would it be bad if starch was broken the whole way down straight away?

Answer 7

Water would flood into the gut and the body wouldn’t be able to control the fluid shift

Question 8

What small intestine disorders are there? (8)

Answer 8

Bleeding
Coeliac disease
Crohn's disease
Infections
Intestinal cancer
Intestinal obstruction
Irritable bowel syndrome (IBS)
Ulcers, such as a peptic ulcer

Question 9

What are the symptoms of small intestinal disorders?

Answer 9

Weight loss - Important
Increased appetite
Steatorrhoea

Question 10

What are the signs of small intestinal disorders?

Answer 10

Weight loss

Low or falling BMI

Question 11

What is steatorrhoea and how does it present?

Answer 11

Fat in the stools

Stools are foul smelling, pale, float and may be oily

Question 12

What is steatorrhoea a result of?

Answer 12

Fat malabsorption

Question 13

What are the signs of malabsorption?

Answer 13

Vitamin B12 and Folate are normally knocked off

Question 14

What are the signs of Vitamin A deficiency?

Answer 14

Night blindness

Falls may be the first signal

Question 15

What are the signs of Calcium, Magnesium and Vitamin D deficiency?

Answer 15

Tetany (Ca def)

Osteomalcia (D of Ca def)

Question 16

What is tetany?

Answer 16

Intermittent muscular spasms caused by parathyroid gland malfunction

Question 17

What is osteomalacia?

Answer 17

Softening of the bones

Question 18

What is the sign for Vitamin K deficiency?

Answer 18

Raised PTR

Iron - Anaemia

Question 19

What is the sign for Vitamin B complex deficiency?

Answer 19

Thiamine leading to memory loss and dementia

Niacin leading to dermatitis and unexplained HF

Question 20

What goes up when people are ill and it must be replaced?

Answer 20

Thiamine demand

Question 21

What is the sign of Vitamin C deficiency?

Answer 21

Scurvy - Swollen bleeding gums and opening of healed wounds

Question 22

What are the non-specific signs of Coeliac and Crohns disease?

Answer 22

Clubbing

Aphtuous Ulcerationn

Question 23

What is the for systemic sclerosis?

Answer 23

Sclerderma

Question 24

What is dermatitis herpetiformis?

Answer 24

Cutaneous manifestation of coeliac disease that blisters and becomes very itchy

Question 25

Where is dermatitis herpetiformis found and what does it deposit in the skin?

Answer 25

Scalp, shoulder, elbows and knees

IgA

Question 26

What investigations are done for small bowel disorders?

Answer 26

Small bowel biopsy/study
White cell scan
CT & MRI enteropgraphy
Capsule enterography
Bacterial overgrowth - Hydrogen breath test
Culture a duodenal or jejunal aspirate

Question 27

How does the hydrogen breath test work?

Answer 27

Patient swallows glucose

Fermented by bacteria straight away and patient will exhale Hydrogen

Question 28

What is the best for a suspicion of coeliac disease?

Answer 28

IgA antibody

Question 29

How come is coeliac disease in the UK?

Answer 29

1:111

Question 30

What causes the reaction in coeliac’s?

Answer 30

Sensitivity to gliadin fraction of gluten

Question 31

What does the response to gliadin cause and what will those with coeliac disease have?

Answer 31

Inflammatory response causing partial or subtotal villous atrophy
Increased intra-epithelial lymphocytes

Question 32

What tests will give a diagnosis of coeliac disease?

Answer 32

Distal duodenal biopsy

Serology

Question 33

What is the treatment for those with coeliac disease?

Answer 33

Withdraw gluten from the diet

Question 34

What complications can occur in the small intestine?

Answer 34

Refractory coeliac disease
Small bowel lymphoma
Oesophageal carcinoma
Colon cancer
Small bowel adenocarcinoma

Question 35

What are the causes of malabsorption? (7)

Answer 35

Inflammation
Infection
Whipples disease
Infiltration
Impaired motility
Iatrogenic
Pancreatic

Question 36

What causes inflammation in the small intestine resulting in malabsorption?

Answer 36

Coeliac disease

Crohns disease

Question 37

What causes infection in the small intestine resulting in malabsorption?

Answer 37

Tropical spure - Folate deficiency
HIV
Giardia Lamblia - Parasite

Question 38

What causes Whipples disease in the small intestine resulting in malabsorption?

Answer 38

Skin, brain, joints and cardiac effects

Weight loss & abdominal pain

Question 39

What causes infiltration in the small intestine resulting in malabsorption?

Answer 39

Amyloid

Question 40

What causes impaired motility in the small intestine resulting in malabsorption?

Answer 40

Systemic sclerosis
Diabetes
Pseudo obstruction

Question 41

What is iatrogenic in the small intestine resulting in malabsorption?

Answer 41

Gastric surgery
Short bowel syndrome
Radiation

Question 42

What pancreatic diseases result in malabsorption?

Answer 42

Chronic pancreatitis

Cystic Fibrosis

Question 43

What is diverticula?

Answer 43

Disease of the small bowel where pouches of mucosa protrude through the colonic muscular wall via weakened areas near blood vessels to form diverticula