Diseases of the Small Intestine

Question 1

What is coeliac disease?

Answer 1

Autoimmune inflammation of small bowel mucosa in response to gluten proteins

Question 2

What genes is coeliac disease associated with?

Answer 2

HLA DQ2 and HLA DQ8

Question 3

What happens histologically in coeliac disease?

Answer 3

villi become flattened, reducing capacity for absorption

Question 4

Symptoms of coeliac disease

Answer 4

asymptomatic, diarrhoea, steatorrhoea, abdo pain, mouth ulcers, angular stomatitis, weight loss, anxiety and depression

Question 5

Investigations into coeliac

Answer 5

Bloods: tTGA IgA, EMA
THEN FOR DIAGNOSIS MUST DO:
Small bowel biopsy - villous atrophy 
Histology - subtotal villous atrophy, crypt hyperplasia + increased lymphocytes 
DEXA bone scan to assess osteoporosis

Question 6

Treatment of coeliac

Answer 6

Mineral and vitamin replacement (compensate of malabsorption)
Gluten-free diet for life - with help of trained dietician

Question 7

Complications of coeliac

Answer 7

Osteoporosis

Enteropathy-assoicated T-cell lymphoma

Question 8

What is the definition of intestinal failure?

Answer 8

Body’s nutritional needs are no longer met by gut due to malabsorption

Question 9

What is acute IF?

Answer 9

Less than 2 weeks i.e. post-chemo

Question 10

What is chronic IF?

Answer 10

Small bowel syndrome

Question 11

What length of small bowel is classified as small bowel syndrome?

Answer 11

< 200 cm (normal 250-850cm)

Question 12

Type I IF definition

Answer 12

Self-limiting, short term, usually post-op

Question 13

Type I IF feeding

Answer 13

Paraenteral nutrition

Question 14

Type II IF definition

Answer 14

Prolonged, sepsis + metabolic compensation, usually complication of abdo surgery

Question 15

Type II IF feeding

Answer 15

Paraenteral +/- enteral nutrition

Question 16

Type III IF definition

Answer 16

Long-term but stable

Question 17

Type III IF feeding

Answer 17

Home parental nutrition

Question 18

What is total parenteral nutrition (TPN)?

Answer 18

When no significant nutrition is obtained from other routes

Question 19

Complications of parenteral nutrition

Answer 19

Misplacement - pneumothorax, atrial puncture
Sepsis
Line fracture/leakage/migration
SVC obstruction

Question 20

Types of enteral nutrition

Answer 20

NG, NJ, percutaneous endoscopic gastrostomy/jejunostomy

Question 21

Where is peripheral nutrition entered into body?

Answer 21

Central/peripheral vein

Question 22

Symptoms of intestinal obstruction

Answer 22

Vomiting, abdo pain, abdo distension and constipation

Question 23

Causes of bowel obstruction

Answer 23

Luminal obstruction, bowel wall obstruction, mesenteric arterial occlusion, strangulation obstructing venous return

Question 24

Luminal obstruction examples

Answer 24

Gallstone ileum, food, bezoar

Question 25

Bowel wall obstruction examples

Answer 25

Tumours, Crohn's. enteritis

Question 26

Mesenteric arterial occlusion examples

Answer 26

Atherosclerosis, thromboembolism from the heart

Question 27

Strangulation obstruction venous return examples

Answer 27

Hernia, adhesion

Question 28

Causes of intestinal failure

Answer 28

Extensive surgery, obstruction, malabsorption, congenital defects

Question 29

What is small bowel syndrome?

Answer 29

When small bowel >50 cm

Question 30

Investigation of small bowel syndrome

Answer 30

FBC, urinalysis, ABGs AXR, contrast CT abdo Enema XR if necessary

Question 31

Symptoms of bowel obstruction?

Answer 31

Severe colicky pain, abdo distention and tenderness, decreased/absent bowel sounds, faeculent bowel sounds, constipation

Question 32

Treatment of bowel obstruction

Answer 32

1. HPN 2. Analgesia, fluids, K+ replacement 3. Anti-embolism measures 4. NG tube draining 5. Surgery if perforation/strangulation/ischaemia - early laparotomy - small bowel transplantation Antibiotics

Question 33

Antibiotics taken for small bowel syndrome

Answer 33

Metronidazole + gentamicin

Question 34

What is Meckel's Diverticulum a remnant of?

Answer 34

The vitello-intestinal duct

Question 35

Symptoms of Meckel's Diverticulum

Answer 35

Asympt, painless malaenia, can mimic appendicitis --> bleeding, perforation, diverticulitis

Question 36

Investigations of Meckel's Diverticulum

Answer 36

Technicium Tc 99M scan - detects ectopic gastric mucosa

Question 37

Treatment of Meckel's Diverticulum

Answer 37

Laparoscopic surgical resection

Question 38

What and where is Meckel's Diverticulum?

Answer 38

Tubercular structure 60cm (ish) from ileocaecal valve

Question 39

Types of primary small bowel tumours

Answer 39

Lymphomas, carcinoids and adenocarcinomas

Question 40

Lymphoma of the small bowel

Answer 40

Maltomas, enteropathy-associated T-cell (coeliac)

Question 41

Lymphoma treatment

Answer 41

Surgery and chemo

Question 42

Carcinoid of small bowel

Answer 42

Small, yellow, slow-growing, locally-invasive, obstructive, found in appendix

Question 43

If carcinoid tumour of appendix metastasis to liver

Answer 43

Carcinoid syndrome

Question 44

What is the presentation of carcinoid syndrome?

Answer 44

Flushing, diarrhoea

Question 45

Treatment of carcinoid of tip of appendix?

Answer 45

Appendectomy

Question 46

Treatment of carcinoid base of appendix

Answer 46

Right hemicoloectomy