Small Intestinal Disorders and Investigation Flashcards
What are the functions of the small intestine?
Digestion
Absorption
Barrier functions
Endocrine and` neuronal control - motility
What is the digestive role of the small intestine?
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
What tests are done to monitor structure of the small intestine?
Small bowel biopsy - endoscopy
CT scan
MRI enterography
Capsule enterography
How do you test for bacterial overgrowth?
H2 breath test (lactulose or glucose substrate)
Culture a duodenal or jejunal aspirate
What are the symptoms of small bowel diseases?
Weight loss Increased appetite Diarrhoea (watery, steatorrhea) Bloating Fatigue
What is steatorrhoea?
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
What is dermatitis herpetiformis? + symptoms
Cutaneous manifestation of coeliac disease Blistering Intensely itchy Affects scalp, shoulders, elbow, knees IgA deposit in skin
What are the confirmatory tests of coeliac disease?
Duodenal biopsy - increased intra-epithelial lymphocytes
HLA status - HLA/DQ2/DQ8 -ve excludes coeliac
Anti-gliadin (only in children)
What is gliadin?
Component of gluten found in wheat, rye and barley
What is the treatment for gliadin sensitivity?
Withdraw gluten
MUST be referred to a state registered dietitian
What are associated conditions of coeliac disease?
Dermatitis herpetiformis IDDM Autoimmune thyroid disease Autoimmune hepatitis Primary biliary cholangitis Autoimmune gastritis Sjogren's syndrome IgA deficiency Down's syndrome
What are the complications of coeliac disease?
Refractory coeliac disease Small bowel lymphoma Oesophageal carcinoma Colon cancer Small bowel adenocarcinoma Osteoporosis
What is refractory coeliac disease?
Ongoing symptoms of coeliac disease even after withdrawal of gluten
Treated with steroids immunosuppressants
What is the treatment for bacterial overgrowth?
Rotating antibiotics (metronidazole, tetracycline, amoxicillin - each for 2 weeks) Vitamin + nutritional supplements