Small Intestinal Disorders and Investigation

Question 1

What are the functions of the small intestine?

Answer 1

Digestion
Absorption
Barrier functions
Endocrine and` neuronal control - motility

Question 2

What is the digestive role of the small intestine?

Answer 2

Decontaminates dirty food
Requires a lot of fluid
Controlled hydrolysis to avoid fluid shifts
Sophisticated control of motility
Absorption against gradients
Onward processing in the liver

Question 3

What tests are done to monitor structure of the small intestine?

Answer 3

Small bowel biopsy - endoscopy
CT scan
MRI enterography
Capsule enterography

Question 4

How do you test for bacterial overgrowth?

Answer 4

H2 breath test (lactulose or glucose substrate)

Culture a duodenal or jejunal aspirate

Question 5

What are the symptoms of small bowel diseases?

Answer 5

Weight loss
Increased appetite
Diarrhoea (watery, steatorrhea)
Bloating 
Fatigue

Question 6

What is steatorrhoea?

Answer 6

Due to fat malabsorption
High fat content in stool
Stool is less dense and floats, difficult to flush
Pale
Foul smelling
May leave oily mark

Question 7

What is dermatitis herpetiformis? + symptoms

Answer 7

Cutaneous manifestation of coeliac disease
Blistering
Intensely itchy 
Affects scalp, shoulders, elbow, knees
IgA deposit in skin

Question 8

What are the confirmatory tests of coeliac disease?

Answer 8

Duodenal biopsy - increased intra-epithelial lymphocytes
HLA status - HLA/DQ2/DQ8 -ve excludes coeliac
Anti-gliadin (only in children)

Question 9

What is gliadin?

Answer 9

Component of gluten found in wheat, rye and barley

Question 10

What is the treatment for gliadin sensitivity?

Answer 10

Withdraw gluten

MUST be referred to a state registered dietitian

Question 11

What are associated conditions of coeliac disease?

Answer 11

Dermatitis herpetiformis
IDDM
Autoimmune thyroid disease
Autoimmune hepatitis
Primary biliary cholangitis
Autoimmune gastritis 
Sjogren's syndrome 
IgA deficiency
Down's syndrome

Question 12

What are the complications of coeliac disease?

Answer 12

Refractory coeliac disease
Small bowel lymphoma
Oesophageal carcinoma
Colon cancer
Small bowel adenocarcinoma
Osteoporosis

Question 13

What is refractory coeliac disease?

Answer 13

Ongoing symptoms of coeliac disease even after withdrawal of gluten
Treated with steroids immunosuppressants

Question 14

What is the treatment for bacterial overgrowth?

Answer 14

Rotating antibiotics (metronidazole, tetracycline, amoxicillin - each for 2 weeks)
Vitamin + nutritional supplements