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Alimentary System: Pathology SA > Small Intestinal Disorders and Investigation > Flashcards

Small Intestinal Disorders and Investigation Flashcards

1
Q

What is the functions of the small intestine

A

Digestion

Absorption

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

Barrier functions

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2
Q

How does the barriers function work against pathogens

A

Immune sampling

Monitoring the presence of pathogens

Translocation of Bacteria

Gut Associated Lymphoid Tissue (GALT)

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3
Q

What structures and features of the small intestine allow it to perform its function

A

Large surface area

  • Villous architecture
  • Constant turnover of cells in crypts & villi

Low Bacterial population
- toxic environment

Motility

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4
Q

How and Where does digestion begin

A

In the stomach by salivary amylase and pepsin

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5
Q

Why is there a controlled digestion in the stomach

A

To avoid osmotic shifts

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6
Q

What happens in the digestion of proteins

A

Breakdown to oligopeptides & amino acids
by Trypsin and chymotrypsin

Final hydrolysis and absorption at brush border

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7
Q

What happens in the digestion of fat

A

Pancreatic lipase breaks don fat into glycerol and free fatty acids
Absorption happens via lacteal and lymphatic system

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8
Q

What happens in the breakdown oc carbohydrates

A

Pancreatic amylase
Breakdown carbohydrate into disaccharides

Final digestion by brush border disaccharidase

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9
Q

What is the symptoms of small intestine disease

A

Weight Loss

Increased appetite

Diarrhoea

Steatorrhoea

Bloating

Fatigue

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10
Q

What is the cause of steatorrhoea

A

Fat malabsorption

causing high fat content on stool

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11
Q

What is the presentation of steatorrhoea

A

Stool less dense and floats

Pale

Foul smelling

May leave an oily mark or oil droplets

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12
Q

What is the signs of small intestine disease

A

Weight loss

Low or falling BMI

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13
Q

What deficiencies can occur due to small intestine disease

A 
Iron 
Vitamin B 12 
Vitamin A,C,D,K
Vitamin B complex 
 - Thiamine 
 - Niacin 
Ca2+
Mg2+
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14
Q

What does a deficiency of iron and Vitamin b12 cause

A

Anemia

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15
Q

What deficiencies result in tetany osteomalacia (muscle spasms and softening of bones)

A

Ca2+
Mg2+
Vitamin D

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16
Q

What deficiency causes night blindness

A

Vitamin A

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17
Q

What deficiency result in a raised prothrombin time rate (PTR) - the time taken for blood to clot

A

Vitamin K

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18
Q

What is scurvy a deficiency of

A

Vitamin C

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19
Q

What does a thiamine deficiency result in

A

Memory,

Dementia

20
Q

What does a Niacin deficiency result in

A

Dermatitis,

Unexplained heart failure

21
Q

What is clubbing and aphthous ulceration (mouth ulcers) a non specific sign of

A

Coeliac disease

Crohns

22
Q

What is scleroderma a non specific sign on

A

Systemic sclerosis

23
Q

What is dermatitis herpetiformis a sign of

A

Is a sign of cutaneous manifestations of coeliac disease

24
Q

What is the presentation of dermatitis herpetiforms

A

Blistering
Intensely itchy
Scalp, shoulders, elbows, knees
IgA deposit in the skin

25
Q

What are examples of non specific signs of small intestine disease

A

Clubbing

Scleroderma

Aphthous Ulceration

Dermatitis herpetiformis

26
Q

What are the investigations for the structure of the small intestine

A

Endoscopy + biopsy

Barium swallow

CT scan

MRI enterography

Capsule enterography

White cell scan

27
Q

How do you specifically test for bacterial overgrowth in the small intestine

A

H2 Breath test
(H2 is a product of bacterial breakdown of lactulose/glucose so will be increased)

or

Culture a duodenal or jejunal aspirate

28
Q

How do you test for coeliac disease

A

Serology -

IgA tests
(more reliable than IgG)

Distal duodenal biopsy

HLA status

29
Q

Why should you check the total plasma IgA in diagnosing coeliac disease

A

Just in case patient has a selective IgA deficiency, so might not make IgA

30
Q

What does distal duodenal biopsy investigate

A

See if there is villous atrophy

either partial/subtotal/total

31
Q

Why do you investigate HLA (human leukocyte antigen) and why is it not that efficient

A

As 97% of coeliacs are either HLA DQ2 or DQ8

but so are 30% of the population

32
Q

What causes Coeliac disease

A

A Sensitivity to Giladin

Component of gluten found in Wheat, Rye, Barley

33
Q

What is the pathology of coeliac disease

A

Produces an inflammatory response
that results in Partial or subtotal villous atrophy
and Increased intra-epithelial lymphocytes

34
Q

What is the enzyme attacked in coeliac disease

A

Tissue Transglutaminase

35
Q

What is the investigations for Coeliac disease

A

Distal duodenal biopsy

Serology: +

  • Anti endomysial IgA
  • Anti Tissue transglutaminase
  • Anti Gliadin (help in children but no diagnostic in adults
36
Q

What is the treatment of coeliac disease

A 
Withdraw gluten 
 (avoid wheat, + lifelong diet)

MUST refer to state registered dietitian

37
Q

What is associated conditions of Coeliac disease

A

Dermatitis herpetiformis

Insulin dependant diabetes mellitus

Autoimmune:
thyroid disease
hepatitis
Gastritis

Primary Biliary cirrhosis

Sjogren syndrome

IgA deficiency

Downs Syndrome

38
Q

What is the complications of Coeliac disease

A

Refractory Coeliac Disease

Small bowel lymphoma

Oesophageal
carcinoma

Colon Cancer

Small bowel adenocarcinoma

39
Q

What is the aetiology of malabsorption

A

Inflammation:

  • Crohns
  • Coeliac disease

Infection

  • Tropical
  • HIV
  • Giardia lamblia (unicellular parasite found in contaminated water)

Whipples Disease

Amyloid (build up of starch/protein)

Impaired motility

  • systemic scerlosis
  • Diabetes
  • Pseudo Obstruction

Iatrogenic

  • Gastric surgery
  • Short bowel syndrome
  • Radiation

Pancreatic

  • Chronic pancreatitis
  • Cystic fibrosis
40
Q

What is the treatment of giardia lamblia

A

Metronidazole

41
Q

What does giardia lamblia result in

A

Hypogammaglobulinaemia

Giardiasis - Causing the symptom of diarrhoea

42
Q

What is the presentation of whiles disease

A

Middle aged men

Skin, brain, joints and cardiac effects

Weight loss

Malabsorption

Abdominal pain

PAS material in villi

43
Q

What is the causative organism of whipples disease

A

Tropheryma whippelii

44
Q

When does small bowel overgrowth happen

A

When there is a condition that affect the motility, gut structure of the immunity of the small intestine

45
Q

How do you treat small bowel overgrowth

A 
Rotating antibiotics:
Metronidazole
Tetracycline
Amoxycillin
Each for 2 weeks

With Vitamin and nutritional supplements

46
Q

Is it easier to test for the function or structure of the small intestine

A

Structure

Alimentary System: Pathology SA (27 decks)

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