Small Intestines

Question 1

What causes duodenal (peptic) ulcers?

Answer 1

Acidic chyme is squirted into the duodenum during stomach emptying
Associated with H.Pylori

Question 2

How does a peptic ulcer present?

Answer 2

Epigastric pain
Usually worse at night
Possible nausea and vomiting
Vomiting relieves pain

Question 3

What investigations can be done for suspected peptic ulcer?

Answer 3

C13 breath test
Serum tests
Stool antigen tests
Endoscopy in older patients to rule out cancer

Question 4

What are potential complications of peptic ulcer?

Answer 4

Perforation
Erosion
Haemorrhage
Possible gastric outlet obstruction

Question 5

What is Coeliac disease?

Answer 5

An immunological reaction to gluten-derived peptides

Question 6

Why does coeliac disease affect the duodenum and jejunum most?

Answer 6

Highest concentrations of gluten present in the duodenum and proximal jejunum

Question 7

What symptoms are present in coeliac disease?

Answer 7

Diarrhoea
Weight loss
Steatorrhoea
Anaemia 
Osteoporosis
Abdominal pain
Fatigue

Question 8

What causes anaemia and osteoporosis in coeliac?

Answer 8

Oedematous, swollen mucosa with deep crypts and short villi lead to poor absorption and digestion = malabsorption

Question 9

What is the treatment for coeliac disease

Answer 9

Gluten free diet is the only treatment

Question 10

What congenital conditions can affect the duodenum?

Answer 10

Atresia
Malrotation
Stenosis
Diverticula

Question 11

What duodenal abnormalities are common in Down’s syndrome?

Answer 11

Atresia (failure to develop) and stenosis

Question 12

What is Meckel’s diverticulum?

Answer 12

Congenital outpouching of the small intestine, left over from umbilical cord

Question 13

What can Meckel’s diverticulum be confused with?

Answer 13

Appendicitis

Question 14

How does appendicitis present?

Answer 14

Vague referred pain in umbilical region that suddenly localises to right iliac fossa
Nausea/vomiting/diarrhoea
Can be confused with other acute inflammations (Meckel’s, Crohn’s)

Question 15

What investigations are done in appendicitis?

Answer 15

Ultrasound

CT is better

Question 16

How is appendicitis treated?

Answer 16

Surgery, often laparotomy

Question 17

What can cause appendicitis?

Answer 17

Commonly caused by obstruction from faecoliths and low fibre diets
Persistent obstruction raises intraluminal pressure above venous pressure reducing epithelial integrity and allows bacterial invasion

Question 18

What symptoms are common in small bowel disorders?

Answer 18

Abdominal pain
Diarrhoea
Flatulence
Weight loss
Nutritional deficiencies