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Year 2- Alimentary > Small Intestine Disorders > Flashcards

Small Intestine Disorders Flashcards

1
Q

Explain how the small intestine fulfills a barrier function?

A
  • As a physical barrier
  • Also by immune sampling. It takes up bacteria of the gut into peyer’s patches where they are broken down and their antigens studied. In this way it monitors the presence of pathogens and trains the immune system against them
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2
Q

Whats an advantage of a bigger intestine?

A

You can afford to lose more to surgery without losing function

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3
Q

Why does the small intestine have a smaller bacterial population than elsewhere in the gut?

A

It has a very toxic environment:
- Digestive enzymes
- Bile Salts
- Presence of IgA

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4
Q

Where is most water absorbed in the gut?

A

The colon but water absorption begins in the ileum

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5
Q

What enzymes break down fat in the small intestine?

A

Pancreatic Lipase

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6
Q

What breaks down carbs at the small intestine?

A

Pancreatic Amylase

Disaccharides are further broken down to monosaccharides at the brush border by disaccharidases (Sucrase, Lactase & maltase)

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7
Q

What are the general symptoms of malabsorption?

A

Weight loss - Low or falling BMI - Increased Appetite
Steatorrhea

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8
Q

What are the characteristics of steatorrhea?

A

Caused by Fat Malabsorption leading to high fat content in stool.
- Less dense and floats
- Pale
- Foul smelling
- May leave an oily mark

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9
Q

You can become deficient in all of the below due to malabsorption disorders. What are the signs of their deficiencies?
- Iron/B12/Folate?
- Ca/Mg/VitaminD?
- Vitamin A?
- Vitamin K?
- Vitamin B Complex?
- Vitamin C?

A

Iron/B12/Folate - Anaemia

Ca/Mg/VitD - Tetany & Osteomalacia

Vitamin A - Night Blindness

Vitamin K - Raised Prothrombin time

Vitamin B Complex
- B1 (thiamine) = dementia
- B3 (Niacin) = Dermatitis & Heart Failure

Vitamin C - Scurvy

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10
Q

List some of the more common small intestinal disorders causing malabsorption?

A
  • Coeliac Disease
  • Crohn’s Disease (Variant of IBD)
  • Systemic Sclerosis
  • Infections
  • Chronic Pancreatitis
  • CF

This is by no means all

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11
Q

Clubbing & Aphthous ulcerations are a sign of what small intestinal disorders?

A

Coeliac & Crohn’s

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12
Q

What is dermatitis herpetiformis and what is it a manifestation of?

A

A cutaneous manifestation of Coeliac Disease.

Blistering & Intense itching on the scalp, shoulders, elbows and kness.

Caused by IgA deposits in the skin

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13
Q

What categories do we divide small intestinal investigations into?

A

Structural (Many)

Functional (Few)

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14
Q

Name some structural small intestine investigations?

A

Endoscopy & Biopsy
Barium Study
CT
MRI or Capsule Enterography
White cell scan

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15
Q

How does a white cell scan work?

A

Take blood
- Filter out White cells
- Tag with radioactive tracer
- Inject back in 2-3 hours later
- White cells gather at place of inflammation or infection

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16
Q

Name an explain one functional small intestinal investigation

A

H2 Breath Test!
Detects lactulose or glucose substrate for bacterial overgrowth.

(You can also culture duodenal fluid)

17
Q

How common is coeliac disease?

A

1-2% of the population

18
Q

What are the symptoms of coeliac disease?

A

General
- Weight loss
- Steatorrhea/Diarrhoea
- Clubbing
- Fall in BMI

Abdominal bloating, cramps and excessive malodorous flatus are also common.

Also possible is dermatitis herpetiformis

Any signs of vitamin deficiencies e.g. anaemia or osteoporosis

19
Q

What tests are there for ceoliac disease?

A
  • Start with Serology
  • If in doubt -> Distal Duodenal Biopsy
  • Can also check HLA status
20
Q

How do we test for coeliac disease serologically?

A

Test for anti tissue-transglutaminase (anti-TTG) IgA antibodies .
2-3% of coeliacs dont make the IgA variant so can test for IgG version.

21
Q

What would show up in a distal duodenal biopsy for coeliac disease?

A

Partial/subtotal/total villlous atrophy due to inflammation causing early death of enterocytes

22
Q

What is “HLA status”?

A

A gene test
97% of coeliacs are either HLADQ2 or DQ8 +ve
However so are 30% of non-coeliacs
Use it for exclusion, if -ve very unlikely to be Coeliac.

23
Q

Explain the pathophysiology of Coeliac disease?

A

Sensitivity to gluten. which is a fraction of gliadin found in wheat.

Gluten -> Inflammation via tissue anti-transglutaminase antibodies -> Villous atrophy & increased intra-epithelial lymphocytes

24
Q

How do we treat celiac disease?

A

Refer to a proper registered dietitian to help them withdraw gluten from their diet for life

25
Q

What foods comes gluten?

A

Wheat/Rye/Barley
Most oat products are contaminated with wheat

26
Q

Name some conditions associated with coeliac disease

A
  • Type 1 diabetes
  • Down’s syndrome
  • IgA Deficiency
  • Dermatitis Herpetiformis
  • Autoimmune Hepatitis & Gastritis
27
Q

What re some common complications of Coeliac Disease?

A
  • Refractory Ceoliac
  • Small bowel lymphoma/oesophageal carcinoma/colon cancer/small bowel adenocarcinoma
28
Q

Causes of malabsorption can be split into several categories such as

A
  • Inflammatory
  • Infections
  • Whipples
  • Infiltratory disease e.g. amyloidosis
  • Conditions causing Impaired Motility
  • Iatrogenic malabsorption
  • Pancreatic diseases
  • Jejunal Diverticular Disease
29
Q

Name a few infective causes of malabsorption

A

HIV

Tropical Sprue
- Folate deficiency is what causes symptoms
- Some sort of bacterial overgrowth as it responds to antibiotics

Giardia Lamblia
- Unicellular Parasite contaminated water
- Responds to Metronidazole
- Causes Hypogammaglobinaemia

30
Q

What is whipples disease?

A

The bacteria Tropheryma Whippelii causing skin, brain, joint, gut and cardiac effects.
It presents with malabsorption, weight loss and abdominal pain

31
Q

How do we test for whipples disease?

A

An endoscopic biopsy

Use a Periodic acid-schiff stain (PAS) will show up macrophages in the mucosa containing the break down products of gram +ve bacilli tropheryma whippelii

32
Q

Amyloidosis? Wuuuuut is it?

A

Amyloid fibrils (protein) builds up in tissues

33
Q

What conditions can cause impaired motility of the Gi tract?

A
  • Systemic Sclerosis
  • Diabetes
  • Pseudo Obstruction
34
Q

What procedures can led to iatrogenic malabsorption?

A

Gastric Surgery
Radiation e.g. from cancer treatment
Short Bowel Syndrome

35
Q

What pancreatic conditions can lead to malabsorption?

A

Think about a lack of pancreatic enzymes reaching the duodenum
E.g. Chronic pancreatitis or cystic fibrosis

36
Q

How does jejunal diverticulosis cause malabsorption?

A

Bacterial overgrowth occurs in the diverticula leading to diverticulitis
Test with a small bowel study then treat with rotating antibiotics:
- Metronidazole
- Tetracycline
- Amoxycillin
Each for 2 weeks

Year 2- Alimentary (37 decks)

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