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Alimentary System > Small Intestinal Disorders and Investigation > Flashcards

Small Intestinal Disorders and Investigation Flashcards

1
Q

State the common disorders affecting the small intestine with particular reference to malabsorption.

A

Inflammation;

  • Coeliac disease
  • Crohn’s disease

Infection;
- Tropical sprue: folate deficiency, responds to antibiotics

Infection;

  • HIV
  • Giardia lamblia: unicellular parasite, contaminated water, responds to metronidazole, hypogammaglobulinaemia
  • Whipple’s disease
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2
Q

State the common disorders affecting the small intestine and the principles of their investigation.

A

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3
Q

State the common disorders affecting the small intestine and the principles of their management.

A

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4
Q

List the medical and surgical causes of the acute abdomen including approaches to diagnosis and management including fluid balance.

A

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5
Q

Explain the concept of maldigestion.

A

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6
Q

Explain the clinical presentation of maldigestion.

A

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7
Q

Explain the management of maldigestion.

A

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8
Q

Explain the concept of malabsorption.

A

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9
Q

Explain the clinical presentation of malabsorption.

A

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10
Q

Explain the management of malabsorption.

A

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11
Q

Describe the functions of the small intestine.

A
  • Digestion: the breaking down of food into its components.
  • Absorption: the passage of nutrients into the body.
  • Barrier functions: regulating what stays in and gets out.
  • Endocrine and neuronal control functions: controlling flow of material from stomach to colon, motility.
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12
Q

Describe the signs of specific vitamin deficiencies.

A
  • Iron: B12, folate
  • Ca2+, Mg2+ and vitamin D: tetany, osteomalacia
  • Vitamin A: night blindness
  • Vitamin K: raised PT (blood will take longer to clot)
  • Vitamin B complex: thiamine (often on refeeding), memory, dementia
  • Niacin: dermatitis, unexplained heart failure
  • Vitamin C: scurvy
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13
Q

Discuss the investigations and management of patients with acute abdominal pain (including conditions such as peritonitis, obstruction and pancreatitis).

A

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14
Q

Compare and contrast pathophysiological causes of abdominal swelling and outline relevant investigations.

A

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15
Q

Describe digestion in the small intestine.

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.

Commences in the stomach;

  • Salivary amylase
  • Pepsin
  • Controlled breakdown to avoid osmotic shifts
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16
Q

Briefly describe the digestion of proteins, fat and carbohydrates.

A

Proteins;

  • Broken down into oligopeptides and amino acids.
  • Trypsin, chymotrypsin
  • Final hydrolysis and absorption at brush border

Fat;

  • Pancreatic lipase
  • Absorption of glycerol and FFAs
  • Via lacteal and lymphatic system

Carbohydrates;

  • Pancreatic amylase
  • Breakdown to disaccharides
  • Final digestion by brush border disaccharidase
17
Q

Describe absorption in the small intestine.

A

Large surface area;

  • Villous architecture
  • Constant turnover of cells in crypts and villi
18
Q

Describe the barrier functions of the small intestine.

A

Low bacterial population (toxic environment);

  • Digestive enzymes
  • Bile salts
  • Presence of IgAm etc.

Maintaining a barrier against pathogens;

  • Immune sampling
  • Monitoring the presence of pathogens
  • Translocation of bacteria
  • Gut Associated Lymphoid Tissue (GALT)
19
Q

Describe small bowel investigations.

A

Tests of structure;

  • Small bowel biopsy: endoscopy
  • CT scan
  • MRI enterography
  • Capsule enterography

Other assorted tests;

  • H2 breath test: lactulose or glucose substrate
  • Culture a duodenal or jejunal aspirate
20
Q

Describe the symptoms of small bowel diseases.

A
  • Weight loss
  • Increased appetite
  • Diarrhoea: usually watery, sometimes steatorrhea
  • Bloating
  • Fatigue
21
Q

Describe steattorhea.

A
  • Fat malabsorption
  • High fat content in stool
  • Stool less dense (floats) and can be difficult to flush
  • Pale
  • Foul-smelling
  • May leave an oily mark or oil droplets
22
Q

Describe the signs of small bowel diseases.

A
  • Signs of weight loss

- Low of falling BMI.

23
Q

Clubbing and aphthous ulceration are non-specific signs of which illnesses?

A
  • Coeliac disease

- Crohn’s disease

24
Q

Scleroderma is a non-specific sign of which illness?

A

Systemic sclerosis.

25
Q

Dermatitis herpetiformis is a non-specific sign of which illness?

A

Cutaneous manifestation of coeliac disease;

  • Blistering
  • Intensely itchy
  • Scalp, shoulder, elbows, knees
  • IgA deposit in skin
26
Q

Describe the serology test for coeliac disease.

A
  • 90% specific and sensitive
  • IgA tests more reliable than IgG
  • Selective IgA deficiency is relatively common (0.1-1% of norm, 2-3% of coeliacs)
  • Thus, always check total plasma IgA as well
27
Q

Describe the confirmatory tests for coeliac disease.

A

Distal duodenal biopsy;

  • Villous atrophy (partial, subtotal, total).
  • Produces an inflammatory response: thought to be via tissue transglutaminase.
  • Increased intra-epithelial lymphocytes.

HLA status;

  • 97% of coeliacs are either HLA DQ2 or DQ8 (so is 30% of norm)
  • Useful to exclude but not confirm in adults

(Anti-gliadin may help in children but not in adults.)

28
Q

State conditions associated with coeliac disease.

A
  • Dermatitis herpetiformis
  • IDDM
  • Autoimmune thyroid disease
  • Autoimmune hepatitis
  • Primary biliary cholangitis
  • Autoimmune gastritis
  • Sjogren’s syndrome
  • IgA deficiency
  • Down’s syndrome
29
Q

Describe the complications of coeliac disease.

A
  • Refractory coeliac disease
  • Small bowel lymphoma
  • Oesophageal carcinoma
  • Colon cancer
  • Small bowel carcinoma
30
Q

Describe the treatment of small bowel bacterial overgrowth.

A
  • Rotating antibiotics: metronidazole, tetracycline, amoxicillin (each for 2 weeks)
  • Vitamin and nutritional supplements

Alimentary System (43 decks)

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