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Systems: Alimentary AB > Small Intestinal Disorders and Investigations > Flashcards

Small Intestinal Disorders and Investigations Flashcards

1
Q

What are the functions of the small intestine?

A
  • Digestion
  • Absorption
  • Endocrine and neuronal control functions
  • Barrier functions
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2
Q

Digestion

A

The breaking of food into its components

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3
Q

Absorption

A

The passage of nutrients into the body

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4
Q

Endocrine and neuronal control functions

A

Controlling the flow of material from the stomach to the colon

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5
Q

Barrier functions

A
  • Regulating what stays in and gets out

- Maintaining a barrier against pathogens

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6
Q

How does the small intestine maintain a barrier against pathogens?

A
  • Immune sampling
  • Monitoring the presence of pathogens
  • Translocation of bacteria
  • Gut associated lymphoid tissue GALT
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7
Q

What is the average length of the small intestine by age 11?

A

250-450cm

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8
Q

How is a large surface area of the small intestine maintained?

A
  • Villous architecture

- Constant turnover of cells in crypts and villi

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9
Q

Why is there a low bacterial population in the small intestine?

A

Toxic environment

  • Digestive enzymes
  • Bile salts
  • Presence of IgA
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10
Q

How is control of digestion maintained?

A
  • Decontamination of dirty food
  • Requires a lot of fluid
  • Controlled by hydrolysis to avoid fluid shifts
  • Sophisticated control of motility
  • Absorption against gradients
  • Onward processing in the liver
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11
Q

What does the commencement of digestion in the stomach involve?

A
  • Salivary amylase
  • Pepsin
  • Controlled breakdown to avoid osmotic shifts
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12
Q

Describe the basic digestion of proteins.

A
  • Breakdown to ogliopeptides and amino acids
  • Trypsin
  • Final hydrolysis and absorption at brush border
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13
Q

Describe the basic digestion of fat.

A
  • Pancreatic lipase

- Absorption of glycerol and free fatty acids via lacteal and lymphatic system

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14
Q

Describe the basic digestion of carbohydrates.

A
  • Pancreatic amylase
  • Breakdown to disaccharides
  • Final digestion by brush border disaccharides
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15
Q

Symptoms of malabsorption

A
  • Weight loss
  • Increased appetite
  • Bloating
  • Fatigue
  • Diarrhoea
  • Steatorrhoea
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16
Q

Steatorrhoea

A
  • Stool that is pale, foul smelling and high in fat content
  • Due to fat malabsorption
  • Stool less dense and floats
  • May leave an oily mark
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17
Q

Signs of malabsorption

A
  • Signs of weight loss

- Low or falling BMI

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18
Q

Signs of iron deficiency

A
  • Anaemia

- Sore tongue

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19
Q

Signs of Ca, Mg and vitamin D deficiency

A
  • Tetany

- Osteomalacia

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20
Q

Signs of vitamin A deficiency

A

Night blindness

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21
Q

Signs of vitamin K deficiency

A

Raised PTR

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22
Q

Signs of vitamin C deficiency

A

Scurvy

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23
Q

Signs of vitamin B complex deficiency

A
  • Thiamine (memory, dementia)

- Niacin (dermatitis, unexplained heart failure)

24
Q

What can clubbing be a non-specific sign of?

A
  • Coeliac disease

- Crohn’s

25
Q

What can scleroderma be a non-specific sign of?

A

-Systemic sclerosis

26
Q

What can aphthous ulceration be a non-specific sign of?

A
  • Coeliac disease

- Crohn’s

27
Q

Dermatitis herpetiformis

A

Cutaneous manifestation of coeliac disease

28
Q

How does dermatitis herpetiformis appear?

A
  • Blistering
  • Intensely itchy
  • Scalp, shoulders, elbows, knees
  • IgA deposit in skin
29
Q

What investigations are there that test the structure of the GIT?

A
  • Small bowel biopsy via endoscopy
  • Small bowel study using barium
  • White cell scan
  • CT
  • MRI enterography
  • Capsule enterography
30
Q

What tests can detect bacterial overgrowth?

A
  • H2 breath test (lactulose or glucose substrate)

- Culture a duodenal or jejunal aspirate

31
Q

Why is IgA sometimes less reliable than IgG as a test for coeliac disease?

A

A significant number of people don’t make IgA in the first place

32
Q

Why should the total plasma IgA be checked?

A

Selective IgA deficiency is relatively common about 0.1-1% of the population but 2-3% of coeliacs

33
Q

What tests can be used to diagnose coeliac disease?

A
  • Distal duodenal biopsy (villous atrophy)

- HLA status

34
Q

What is the prevalence of coeliac disease?

A
  • 1:111 in UK

- 1:300 clinical diagnosis

35
Q

What is coeliac disease a sensitivity to?

A

Gliadin fraction of Gluten

36
Q

Where is gliadin found?

A
  • Wheat
  • Rye
  • Barley
37
Q

What is the pathology behind coeliac disease?

A
  • Produces an inflammatory response thought to be via tissue transglutaminase
  • Partial or subtotal villous atrophy
  • Increased intra-epithelial lymphocytes
38
Q

What is the gold standard diagnostic test for coeliac disease?

A

Distal duodenal biopsy

39
Q

What serology is looked for in coeliac disease?

A
  • Anti- endomysial IgA
  • Anti Tissue transglutaminase
  • Anti gliadin may help in children but not diagnostic in adults
40
Q

What is the treatment for coeliac disease?

A
  • Withdraw gluten

- Referral to state registered dietician

41
Q

What conditions are associated with coeliac disease?

A
  • Dermatitis herpetiformis
  • IDDM
  • Autoimmune thyroid disease
  • Autoimmune hepatitis
  • Primary biliary cirrhosis
  • Autoimmune gastritis
  • Sjogren syndrome
  • IgA deficiency
  • Downs syndrome
42
Q

What complications can there be with coeliac disease?

A
  • Refractory coeliac disease
  • Small bowel lymphoma
  • Oesophageal carcinoma
  • Colon cancer
  • Small bowel adenocarcinoma
43
Q

What inflammatory causes of malabsorption are there?

A
  • Coeliac disease

- Crohn’s

44
Q

What infectious causes of malabsorption are there?

A
  • Tropical sprue
  • HIV
  • Giardia lamblia
45
Q

Tropical sprue

A

Folate deficiency which responds to antibiotics

46
Q

Giardia lamblia

A

Unicellular parasite found in contaminated water that can cause hypogammglobulinaemia and responds to metronidazole

47
Q

What can Whipples disease cause?

A
  • Skin, brain, joints and cardiac effects
  • Weight loss
  • Malabsoprtion
  • Abdominal pain
  • PAS material in villi
48
Q

Who is usually affected by Whipples disease?

A

Middle aged men

49
Q

What organism is responsible for Whipples disease

A

Tropheryma whippelli

50
Q

What infiltrative causes of malabsorption are there?

A

Amyloid

51
Q

What impaired motility causes of malabsorption are there?

A
  • Systemic sclerosis
  • Diabetes
  • Pseudo obstruction
52
Q

What iatrogenic causes of malabsorption are there?

A
  • Gastric surgery
  • Short bowel syndrome
  • Radiation
53
Q

What pancreatic causes of malabsorption are there?

A
  • Chronic pancreatitis

- Cystic fibrosis

54
Q

Small bowel overgrowth can occur in any condition that affects…

A
  • Motility
  • Gut structure
  • Immunity
55
Q

How should bacterial overgrowth be treated?

A

Rotating antibiotics, each for 2 weeks

  • Metronidazole
  • Tetracylcine
  • Amoxycillin

Vitamin and nutritional supplements

Systems: Alimentary AB (37 decks)

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