Diseases of small intestine Flashcards by Alexander Turner

Duodenum is responsible for absorbing what?

Iron**, calciuim, phophorus, mag, copper, thiamin, riboflavin

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Jejunum absorbs what?

ADEK and **Folate

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Ileum

B12, bile salts/acids

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What is Celiac disease

Gluten sensitive enteropathy

Diffuse damage to the proximal small intestinal mucosa (immune)

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Celiac disease is “Grossly” underdiagnosed. What clinical signs should we be on the look out for?

GI issues including **Steatorrhea, flatulance, borborygmi, weakness/muscle wasting

Extraintestinal - Fatigue, depression, Iron def, transaminitis, *****Dermatitis herpetiformis

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What is dermatitis herpetiformis

Pruritic papules and vesicle (herpes like)

Extensor surfaces of extremities, trunk, scalp, neck

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What labs should be drawn for Celiac?

CBC, CMP, UA (rule out stuff)

Specific serology:
IGAtTG antibody- ***Test of Choice… if neg, draw serum IgA (maybe IgA def.)

IgG-deamidated gliadin peptides (DGPs)
-If you have an identified IgA def

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Describe IgA function and abundance

Function - Protect mucosal tissue from the microbial invasion and maintain immune homeostasis

*most abundant

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If we have positive serology for celiac disease, what should we do to confirm or exclude diagnosis?

Mucosal biopsy of **proximal small intestine

Looking for blunting or atrophy of intestinal villi

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Describe the overarching diagnostic approach for celiac

HPE
Serologic testing algorithm
Try to eliminate all gluten (2-3 weeks should be good)
Mucosal biopsy

Refer to dietician.

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Celiac disease carries a SLIGHT increased risk of what?

lymphoma and adenocarcinoma

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What is Whipple disease?

Rare multisystem illness caused by T. Whippelii

Common in white males 30-50

No human spread

Contact with sewage/waste

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What is the classic patient presentation with whipple disease?

Pt w/

Migratory arthralgia (large joint)
Diarrhea (flatulance, steatorrhea)
ABD pain, weight loss, fever

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How do we establish diagnosis for whipple disease?

Mucosal biopsy w/ evidence of bacterium

“Foamy macrophages”

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How do we treat whipple?

IV ceftriaxone x 2 wks

2. THEN** (not or) TMP-SMX DS PO (septra) x 1 year

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What is tropical sprue? Where is it found?

Tropics (no shit) N/S of equator to 30 degrees

Chronic diarrheal disease characterized by entire small intesting involvment and ** folic acid and B12

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What are the hallmark s/sx of tropical sprue

CHRONIC diarrhea
Steatorrhea
weight loss
anorexia
malaise
**B12 and Folate deficiency (glossitis and chelitis)

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What labs/procedures do we use to diagnose tropical sprue?

CBC - Megaloblastic anemia

Endoscopy w/ biopsy - Flattening of duodenal folds and blunted villi w/ elongated crypts

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What is prevention and treatment of Tropical sprue?

Prev = boil water and peel fruit

TX = Septra x 6 months (TMP-SMX). Folate and B12.

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What happens to malabsorbed lactose?

It gets fermented by intestinal bacteria which produces gas and organic acids.

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As intake of lactose increases in lactade deficiency, what else increases?

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Symptoms - Small –> asymptmatic, Large = osmotic diarrhea

Should signs of general malabsorption be present in lactase deficiency?

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No… If wt loss, look for other diagnosis

What are our treatment options for Lactase deficiency

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Presumptive = Stop 2-3 weeks and observe

Diagnose = Hydrogen breath test ***

Then treat with *Titration to patient symptoms.

What products are available for people with lactase deficiency?

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Lactase-enhanced products

Lactase enzyme replacement supplements

When should we consider Bacterial Overgrowth in patients?

1. Pt on chronic PPI (gastric *achlorhydria) 2. Anatomic abnormality of small intestine 3. Small intestine motility disorder 4. Gastrocolic or coloenteric fistula (crohns, cancer, surg resect)

What are the symptoms of bacterial overgrowth?

Flatulance, wt loss, abd pain, diarrhea, steatorrhea, **Macrocytic anemia Pair w/ patient risk catagory*********

How do we treat a bacterial overgrowth

Cipro --> Augmentin --> Rifaximin

Removing a segment of the small intestine can cause what? What is this?

Short Bowel Syndrome Malabsorption secondary to shit being gone... Depends on the length, location etc...

An acute paralytic ileus (AKA adynamic or post-operative) lacks what? What is it usually secondary to?

No mechanical obstruction ``` ABD surgery (immediate post) Severe illness (inpatient) Intestinal motility drugs (opiods, Antichols) ```

What S/Sx do we look for in Acute Paralytic Ileus?

CONSTANT abdominal pain - diffuse NO abdominal TTP - no peritonitis DIMINISHED bowel sounds - or absent N/V and distention*

What is the diagnostic test of choice for acute paralytic ileus?

Plain ABD x-ray shows gas filled loops of either bowel Also, get labs to see if you need to fix stuff.

How do we treat Acute paralytic ileus?

Supportive Tx illness, pain, fluid/electrolytes, *bowel rest, *Nasogastric decompression if sever or vomit

What is a Chronic Intestinal Psuedo Obstruciton

S/SX similar to gastroparesis Looks like an obstruction but there isnt one. (Psuedo....)

What should we do to diagnose CIPO?

CT or endoscopy to r/o obstruction If none, fix malnutrition or electrolyte imbalance... Refer them to GI

Small bowel obstruction is most commonly attributed to what?

Postoperative adhesions or hernias

Besides the most common cause, what other things can cause SBO?

``` Neoplasms Strictures Foreign Body Intussusception Gallstones (gallstone ileus) ```

What are the risk factors for SBO?

``` Prior ABD or pelvic surgery ** ABD wall or groin hernia ** Prior irradiation Foreign body ingestion Neoplasm shit and inflammation ```

How will a patient present with an SBO?

COLICKY abdominal pain Nausea, vomiting, OBSTIPATION ABD DISTENTION w/ TYMPANY HYPERACTIVE--> HYPOACTIVE sounds dehydrated

How do we workup a suspected SBO patient?

CBC, CMP, UA, Type and cross for surg Plain ABD film** CT if pt has systemic signs or **Localized ABD pain (r/o strangulation)***

We have diagnosed a SBO. How do we treat the pt?

EARLY SURGICAL CONSULT ADMIT this patinet TX supportive : Fluid resus, Decomp bowel, pain, anti emetic.

What is a gallstone ileus? Who is most likely to have this?

Impaction of gallstone in ileum after going through biliary-enteric fistula.... Must have gallstones (Four F's)

Telescoping intestine (invagination) is known as what? What can it cause? What is seen in kids?

Intussusception Bowel Obstruction Currant Jelly Stool (red)

Primary malignancy for SI is _______. But a neoplasm may cause what?

Rare Intussusception

Differentiate Adenocarcinoma and lymphoma of the small intestine

Adenocarcinoma - duodenum of prox jejunum. Obstruction, Chronic GI bleed or weight loss Lymphoma - assoc w/ aids, immunosuppres, Crohns

What is Protein-losing enteropathy? Why would we get it? What should we do about it

Loss of serum protein (hypoalbuminemia) into the GI tract Secondary to established disorder CMP/BMP to diagnose Replace it via diet or straight up Albumin

List types of Mesenteric Ischemia

Acute arterial occlusion - emboli/thrombus Mesenteric venous thrombosis Non-occlusive - Low card output, Vasospasm

What is the classic physical exam sign for Mesenteric Ischemia?

Pain out of proportion to exam **look at history of cardiac issues too

What test diagnosis Mesenteric ischemia? How do we treat it?

CT angiography Admit Papaverine* - smooth muscle relaxer Thrombolytics Surgical referral

Meckel's diverticulum is a _______ abnormality, it follows the rules of ______

Congenital (most common) Two

What is the rule of twos?

Meckels diverticulum 2% population 2:1 male-femal 2 types of mucosa 2 years old or younger

How will a patient with Meckel's present? How do we diagnose? How do we treat?

GI bleed from mucosa with Abdominal pain (like apendicitis pain) Kid under 10 = painless bleeding w/ IBD symptoms Adults under 40 w/ unidentified GI bleed ****Diagnose w/ capsule endoscopy of Meckels nuclear (99m tech pertech) Tx = Stabilize and refer to surgery.

Diseases of small intestine Flashcards

(51 cards)