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2A - Alimentary System > Small Intestinal Disorders and Investigations > Flashcards

Small Intestinal Disorders and Investigations Flashcards

1
Q

What is digestion?

A

Breaking down of food into its components

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2
Q

What is absorption?

A

Passage of nutrients into the body

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3
Q

What are the functions of the small intestine?

A

Digestion

Absorption

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

Barrier functions

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4
Q

When is the full length of the small intestine reached?

A

Usually by age 11

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5
Q

What is the average length of the small intestine?

A

2.5-4.5m

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6
Q

What allows the small intestine to have such as large surface area?

A

Villous architecture

Constant turnover of cells in crypts and villi

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7
Q

Why does the small intestine have a low bacterial population?

A

Toxic environment due to digestive enzymes, bile salts and IgA

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8
Q

What does maintaining control of digestion require?

A

Lots of fluid

Controlled hydroplysis to avoid fluid shifts

Sophisticated control of motility

Absorption against gradients

Onwards processing in the liver

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9
Q

What enzymes are in the stomach for digestion?

A

Salivary amylase

Pepsin

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10
Q

Why must digestion in the stomach be controlled?

A

Avoid osmotic shifts

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11
Q

What are proteins broken down into?

A

Oligopeotides and amino acids

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12
Q

What enzymes control the breakdown of protein?

A

Trypsin and chymotrypsin

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13
Q

What enzyme controls the breakdown of fat?

A

Pancreatic lipase

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14
Q

What is fat broken down into?

A

Glycerol and free fatty acids

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15
Q

What enzyme controls carbohydrate breakdown?

A

Pancreatic amylase

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16
Q

What does pancreatic amylase break carbohydrates down into?

A

Disaccharides

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17
Q

What does the final digestion of carbohydrates?

A

Brush border disaccharidase

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18
Q

What are symptoms of small intestine disorders?

A

Weight loss

Increased appetite

Diarrhoea

Sometimes steatorrhoea

Bloating

Fatigue

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19
Q

What is steatohoea caused by?

A

Fat malabsorption

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20
Q

What is poo like for someone who has steatorrhoea?

A

High fat content

Stool less dense and floats

Pale

Foul smeeling

May leave an oily mark or oil droplets

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21
Q

What are signs of small intestinal disorders?

A

Signs of weight loss such as low or falling BMI

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22
Q

What are some examples of possible vitamin/mineral deficiencies?

A

Iron

B12

Ca2+, Mg2+

D

B9 (folate)

A

K

B complex

C

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23
Q
A
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24
Q

What are signs of calcium, magnesium and vitamin D deficiency?

A

Tatany

Osteomalacia

25
Q

What is a sign of vitamin A deficiency?

A

Night blindness

26
Q

What is a sign of vitamin K deficiency?

A

Raised PTR

27
Q

What are signs of thiamine deficiency?

A

Memory, dementia

28
Q

What are signs of niacin deficiency?

A

Dermatitis, unexplained heart failure

29
Q

What is a sign of vitamin C deficiency?

30
Q

What is clubbing a sign of?

A

Coeliac disease

Crohn’s disease

31
Q

What is scleroderma a sign of?

A

Systemic sclerosis

32
Q

What is aphthous ulceration a sign of?

A

Coeliac disease

Crohn’s disease

33
Q

What is dermatitis herpetiformis?

A

Cutaneous manifestation of coeliac disease:

blistering

intensely itchy

scalp, shoulders, elbows, knees

IgA deposits on skin

34
Q

What tests can be done to look at the structure of the small bowel?

A

Endoscopy

Barium study

CT scan

MRI enterography

Capsule enterography

White cell scan

Bacterial overgrowth tests (H2 breath test, or culture a duodenal or jejunal aspirate)

35
Q

What is measured in an H2 breath test?

A

Lactulose or glucose substrate

36
Q

What tests can be done for small intestine function?

A

Very few compared to structure

37
Q

Are IgA or IgG tests more reliable?

38
Q

Who often has selective IgA deficiency?

A

Coeliacs (3%)

39
Q

What are confirmational tests for coeliac disease?

A

Distal duodenal biopsy (looking for villous atrophy and HLA status)

40
Q

What is coeliac disease?

A

Autoimmune disease where the small intestine becomes inflammed

41
Q

What is gliadin?

A

Class of proteins present in wheat, rye and barley

42
Q

What is gliadin a component of?

43
Q

What is the pathology of gliadin in people with Coeliac disease?

A

Produces an inflammatory response

Partial or subtotal villous atrophy

Increased intra-epithelial lymphocytes

44
Q

What is done to diagnose people allergic to gliadin

A

Distal duodenal biopsy

Serology (anti endomysial IgA, anti-tissue transglutaminase)

46
Q

Though what tissue does gliadin produce an inflammatory response through?

A

Thought to be transglutaminase

47
Q

What is the treatment for people allergic to gliadin?

A

Withdraw gluten

Refer to state registered dietitian

48
Q

What are some associated conditions with gliadin allergy?

A

Dermatitis herpetiformis

IDDM

Autoimmune thyroid disease

Primary biliary cirrhosis

Autoimmune hepatitis

49
Q

What are some complications of gliadin allergy?

A

Refractory coeliac disease

Small bowel lymphoma

Oesophageal carcinoma

Colon cancer

Small bowel adenocarcinoma

50
Q

What are different categories of causes of malabsorption?

A

Inflammation

Infection

Infiltration

Impaired motility

Iatrogenic

Pancreatic

51
Q

What are some diseases that cause malabsorption through inflammation?

A

Coeliac disease

Crohn’s disease

52
Q

What are some infections that can cause malabsorption?

A

Tropical sprue

HIV

Giardia lamblia

Whipple’s disease

53
Q

What is an infiltrative cause of malabsorption?

54
Q

What are diseases that can cause impaired motility leading to malabsorption?

A

Systemic sclerosis

Diabetes

Pesudo-obstruction

55
Q

What are some iatrogenic causes of malabsorption?

A

Gastric surgery

Short bowel syndrome

Radiation

56
Q

What are some pancreatic causes of malabsorption?

A

Chronic pancreatitis

Cystic fibrosis

57
Q

Small bowel overgrowth can occur in any condition that affects what?

A

Motility

Gut structure

Immunity

58
Q

What is small bowel overgrowth diagnosed by?

A

H2 breath test

59
Q

What is the treatment for small bowel obergrowth?

A

Rotating antibiotics

2A - Alimentary System (41 decks)

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