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GI > Small Intestinal Disorders and Investigation > Flashcards

Small Intestinal Disorders and Investigation Flashcards

1
Q

Functions of the small intestine?

A
  • Digestion
  • Absorption
  • Barrier functions (control what gets out/in)
  • Endocrine/neuronal control functions (motility control)
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2
Q

Where does protein breakdown occur?

A
  • Commences in the stomach: pepsin

- Small intestine: trypsin/chymotrypsin, final hydrolysis and absorption at brush border

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3
Q

Where is fat broken down and how is it absorbed?

A

In the small intestine

Absorbed via the lacteal & lymphatic system

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4
Q

How does the bacterial population of the small intestine compare to that of the large intestine? Why is this?

A

Much smaller

Toxic environment in the SI:

  • digestive enzymes
  • Bile salts
  • IgA
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5
Q

What are the barrier functions of the small intestine?

A
  • Keep bacterial population low

- Maintain a barrier against pathogens (via immune sampling, gut associated lymphoid tissue)

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6
Q

Investigations for examining small bowel structure?

A
  • Endoscopy + biopsy
  • CT scan
  • MRI enterography
  • Capsule enterography
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7
Q

What is capsule enterography?

A

Inserting a capsule with lights, a lens and an imager into the small bowel of the patient to view the structure of the small intestine

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8
Q

How can you test for bacterial overgrowth in the small bowel?

A
  • H2 breath test

- Culture a duodenal or jejunal aspirate

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9
Q

Signs of small bowel disease?

A
  • Weight loss
  • Increased appetite
  • Diarrhoea (sometimes steatorrhoea)
  • Bloating
  • Fatigue
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10
Q

What is steatorrhoea?

A

It is a condition of the small bowel due to fat malabsorption, resulting in:

  • High fat content in stool
  • Less dense stool, floats
  • Pale coloured, foul smelling stool that may leave an oily residue
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11
Q

Signs of calcium, magnesium and/or vitamin D deficiency?

A

Tetany

Osteomalacia

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12
Q

Signs of vitamin A deficiency?

A

Night blindness

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13
Q

Signs of vitamin K deficiency?

A

Raised prothrombin time

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14
Q

Signs of vitamin C deficiency?

A

Scurvy

Swollen, bleeding gums
Easy bruising
Fatigue & Irritability

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15
Q

Signs of vitamin B complex malabsorption?

A

Thiamine - Memory, dementia

Niacin - dermatitis, unexplained heart failure

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16
Q

What GI diseases is finger clubbing a sign for?

A

Coeliac Disease

Crohn’s

17
Q

What is Aphthous Ulceration? What GI conditions is a sign of?

A

It is benign, non-contagious ulceration of the mouth

Coeliac disease
Crohn’s

18
Q

What is dermatitis herpetiformis? What GI conditions is it a sign of?

A

It is areas of intensely itchy blistering on the skin (scalp, shoulders, elbows & knees) - IgA deposits in skin

Sign of coeliac disease

19
Q

What is Coeliac Disease?

A

An autoimmune disease characterized by hypersensitivity to gluten - when gluten is consumed inflammation occurs in the small intestine causing malabsorption

20
Q

Symptoms of coeliac disease?

A 
Fatigue 
Bloating 
Variable stools (diarrhoea)
Abdominal pain  
Anaemia
21
Q

Tests for coeliac disease?

A

Gold standard is distal duodenal biopsy - villous atrophy?

Serology - IgA/IgG levels should be elevated (IgA more sensitive than IgG)

Bloods (malabsorption): Fe, Folate, Ca, B12

22
Q

What is gliadin?

A

Subunit of gluten - often reason for hypersensitivity response

(found in wheat, rye and barley but not rice and maize)

23
Q

Treatment of coeliac disease?

A

Gluten free diet - lifelong

Must refer patient to registered dietician

24
Q

Conditions associated with Coeliac disease?

A 
Dermatitis herpetiformis 
Diabetes mellitus 
Autoimmune thyroid disease
Autoimmune hepatitis 
Autoimmune gastritis 
IgA deficiency 
Downs
25
Q

Main complications of coeliac disease?

A

Refractory coeliac disease
Small bowel lymphoma
Small bowel adenocarcinoma
Osteopenia

Oesophageal carcinoma
Colon cancer

26
Q

What is refractory coeliac disease?

A

Persistent or recurrent malabsorptive symptoms and villous atrophy despite strict adherence to gluten free diet for 6-12 months

27
Q

Small bowel conditions causing malabsorption?

A

Coeliac disease
Crohn’s
Infection (tropical sprue)

28
Q

What is giardisis? What parasite causes it?

A

Infection of the small intestine

  • caused by Giardia Lamblia (contaminated water)
29
Q

What is Whipple’s disease? What are its effects?

A

Bacterial infection - most affects joints and digestive system (also brain & cardiac effects)

Causes malabsorption which leads to weight loss, abdominal pain

30
Q

Organism causing Whipple’s disease?

A

Tropheryma whippelii

31
Q

If suspected bacterial overgrowth in the small bowel what is the recommended treatment?

A

Rotating antibiotics - metronidazole, tetracycline, amoxicillin

Each for 2 weeks

32
Q

Important step in treatment of many small bowel disorders that you’re probs gonna forget?

A

Nutritional support

GI (46 decks)

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