Small Intestine Conditions Flashcards
Describe the pathophysiology of coeliac disease
Proteins containing gluten are resistant to absorption so remain in the lumen
This triggers immune response
Immune response causes inflammation
Inflammation leads to villous atrophy and crypt hyperplasia
This causes malabsorption of other nutrients
What are the diseases associated with coeliac disease?
Type 1 diabetes
IBD
IgA deficiency
Signs and symptoms of coeliac disease
Abdominal pain Weight loss Diarrhoea/steatorrhoea Angular stomatitis Dermatitis herpetiformis on the extensor surface of elbows Anaemia Malnutrition
What are the long term problems of coeliac disease?
Iron or folate deficiency
Osteoporosis
What are the first line investigations for coeliac disease?
Serology - either:
- tTG antibodies
- EMA
What are the second line investigations for coeliac disease?
Endoscopic biopsy
Which additional investigations may be done for coeliac disease?
HLA by specialists if necessary
Iron and folate levels to check for deficiency
Bone scan
What are the steps taken for management in coeliac disease?
Gluten free diet Vitamin supplements Pneumococcal vaccines when patients have splenic atrophy Annual blood tests Screen for autoimmune conditions
What are the symptoms of GI malabsorption?
Diarrhoea
Weight loss
Bloating
Abdo pain
What are some common causes of malabsorption?
Coeliac Crohn's Lactose intolerance Chronic pancreatitis Biliary obstruction Liver cirrhosis
What are signs of GI malabsorption?
Anaemia
Oedema
Steatorrhoea
What is tropical sprue?
A rare disease that affects small bowel absorption
What is the pathophysiological effect in tropical sprue?
Atrophy of villi of the digestive wall, which causes malabsorption
What are the symptoms of tropical sprue?
Fatigue
Diarrhoea
Anorexia
What is the management for tropical sprue?
Antibiotics
Supplements
What does vitamin C deficiency cause, and what are the symptoms?
Scurvy
- Gum disease
- Anorexia
- Weakness
What does vitamin D deficiency cause?
Osteomalacia
Rickets
What is malnutrition?
The state of nutrition where a deficiency or imbalance of energy and nutrients lead to adverse effects on body tissue, function and clinical outcome
What is enteric nutrition?
Nutrients are delivered into the stomach or small intestine via a tube
What is parenteral nutrition?
Nutrient solution is delivered via a central or peripheral vein
Where can secondary tumours in the small bowel metastasise from?
Ovary
Colon
Stomach
Where do adenocarcinomas of the small intestine occur most often?
Duodenum and jejunum
Which is the most common type of tumour in the small intestine?
Adenocarcinoma
What is the management for adenocarcinomas and lymphomas?
Surgical resection + radiotherapy + chemotherapy
Where do lymphomas of the small intestine occur most often?
Ileum
Where do carcinoid tumours of the small intestine metastasise to?
Liver
Where are carcinoid tumours of the small intestine most commonly found?
Terminal ileum and appendix
Are carcinoid tumours mainly asymptomatic?
Yes
When does carcinoid syndrome occur?
If a carcinoid tumour has metastasised
What is a key hormone that is overproduced in carcinoid syndrome, and what effects does it cause?
Serotonin
Increased motility, bronchospasm, production of collagen via fibroblasts in the heart
What are the symptoms of carcinoid syndrome?
Diarrhoea
Spontaneous flushing
Shortness of breath/wheezing
Pulmonary stenosis or tricuspid incompetence
What are the investigations used for carcinoid tumours?
Serum chromogranin A
24 hour urine secretion of 5-hydroxyindoleacetic acid
Radiological imaging for metastases
What is the management for carcinoid tumours?
Surgical resection
Octreotide pr lanreotide to alleviate symptoms
