Small Intestinal Disorders and Investigation Flashcards

1
Q

What are the functions of the small intestine?

A

Digestion
Absorption
Barrier functions
Endocrine and` neuronal control - motility

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2
Q

What is the digestive role of 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
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3
Q

What tests are done to monitor structure of the small intestine?

A

Small bowel biopsy - endoscopy
CT scan
MRI enterography
Capsule enterography

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4
Q

How do you test for bacterial overgrowth?

A

H2 breath test (lactulose or glucose substrate)

Culture a duodenal or jejunal aspirate

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5
Q

What are the symptoms of small bowel diseases?

A
Weight loss
Increased appetite
Diarrhoea (watery, steatorrhea)
Bloating 
Fatigue
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6
Q

What is steatorrhoea?

A
Due to fat malabsorption
High fat content in stool
Stool is less dense and floats, difficult to flush
Pale
Foul smelling
May leave oily mark
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7
Q

What is dermatitis herpetiformis? + symptoms

A
Cutaneous manifestation of coeliac disease
Blistering
Intensely itchy 
Affects scalp, shoulders, elbow, knees
IgA deposit in skin
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8
Q

What are the confirmatory tests of coeliac disease?

A

Duodenal biopsy - increased intra-epithelial lymphocytes
HLA status - HLA/DQ2/DQ8 -ve excludes coeliac
Anti-gliadin (only in children)

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9
Q

What is gliadin?

A

Component of gluten found in wheat, rye and barley

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10
Q

What is the treatment for gliadin sensitivity?

A

Withdraw gluten

MUST be referred to a state registered dietitian

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11
Q

What are associated conditions of coeliac disease?

A
Dermatitis herpetiformis
IDDM
Autoimmune thyroid disease
Autoimmune hepatitis
Primary biliary cholangitis
Autoimmune gastritis 
Sjogren's syndrome 
IgA deficiency
Down's syndrome
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12
Q

What are the complications of coeliac disease?

A
Refractory coeliac disease
Small bowel lymphoma
Oesophageal carcinoma
Colon cancer
Small bowel adenocarcinoma
Osteoporosis
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13
Q

What is refractory coeliac disease?

A

Ongoing symptoms of coeliac disease even after withdrawal of gluten
Treated with steroids immunosuppressants

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14
Q

What is the treatment for bacterial overgrowth?

A
Rotating antibiotics (metronidazole, tetracycline, amoxicillin - each for 2 weeks)
Vitamin + nutritional supplements
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