Gen Surg: Small intestine disease and malabsorption (not including coeliac disease) Flashcards
(50 cards)
What are symptoms of GI malabsorption?
- Diarrhoea
- Weight loss
- Lethargy
- Steatorrhoea
- Bloating
What signs are common in GI malabsorption disorders?
Signs of deficiencies
- Anaemia
- Bleeding disorders
- Oedema - protein deficeincy
- Pathological fractures
- Neurological features - neuropathy
What are disorders of the small intestine which can cause malabsorption?
- Coeliac disease/dematitis herpatiformis
- Tropical sprue
- BActerial overgrowth
- Intestinal resection
- Whipple’s Disease
- Radiation enteropathy
- Parasitic infestation
What investigaitons would you consider doing in someone who was displaying features of GI malabsorption?
- Bloods - FBC, Ca2+, Iron Studies, B12 + folate, INR, Lipid profile, Coeliac screen
- Imaging - Endoscopy + SB biopsy
- Other - Stool culture, Hydrogen breath test
What is tropical sprue?
A condition presenting with chronic diarrhoea and malabsorption that occurs in residents or visitors to affected tropical areas.
The term is reserved for severe malabsorption (2 or more substances) accompanied by diarrhoea and malnutrition
What is the cause of tropical sprue?
Unknown aetiology - likely to be infective
What is the pathology of tropical sprue
Malabsorption of fat and vit B12, vilous atrophy, inflammation
Presentation of someone with tropical sprie
-
Changes in bowel habit
- Steatorhoea,
- Diarrhoea
- Bloating
- Foul smelling/greasy stools
- Fever
- Leg swelling - hypoproteinaemia
- Hair loss
- Anaemia - pallor, angular stomatitis
- Glositis in vit B12 deficiency
Investigations tropical spurae
-
Blood tests
- FBC:
- Folate deficiency
- B12 deficiency
- Megaloblastic anaemia
- Iron, folate, B12 (all absorbed at small intestina)
- FBC:
- D-xylose test (+ve in 94-100%)
- Might consider O+P to rule out parasitice cause
- Stool culture - bacterial cause
-
Imaging
- DISTAL DUODENAL ENDOSCOPY AND BIOPSY
How would you manage someone with tropical sprue?
- Remove from spure area
- Consider Folic acid/B12
- Consider Abx (tetracycline)
How would you approach investigating someone with suspected tropical sprue?
Investigations as for malabsorption (bloods, endoscopy etc.) - exclude infectious causes of diarrhoea
What is bacterial overgrowth?
A disorder of excessive bacterial growth in the small intestine. Unlike the colon (or large bowel), which is rich with bacteria, the small bowel usually has fewer than 10,000 organisms per millilitre
What are the main features of bacterial overgrowth?
- Diarrhoea/steatorrhoea
- Features of B12 deficiency
What investigation is used to confirm bacterial overgrowth?
Hydrogen breath test
What is involved in the hydrogen breath test?
- Mouth rinsed out with an antiseptic mouthwash beforehand.
- Take samples of end-expired air before giving lactulose
- Appearance of a breath hydrogen peak after oral lactulose is used to estimate mouth to caecum transit time
- An earlier rise in the breath hydrogen after lactulose indicates bacterial breakdown in the small intestine.
What result on hydrogen breath test indicates bacterial overgrowth?
Early increase in exhaled hydrogen = overgrowth
How would you manage someone wit bacterial overgrowth?
- Treat cause - e.g. resect stricture
- Consider rotatiing course of Abx
What can happen if too much small bowel is resected?
Small bowel syndrome
What nutrient abnormalities occur in ileal resection?
B12
What problems can occur in ileal resection?
- Bile-salt induced diarrhoea
- Steatorrhoea
- Gallstone
- Urinary stones formation
- B12 deficiency
What is short-bowel syndrome?
Intestinal failure resulting from obstruction, dysmotility, surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance
What is the major problem that can occur if small bowel is resected and a terminal small bowel stoma is put in place?
Sodium and fluid depletion - majority of patients with ≤100 cm of jejunum remaining will require parenteral supplements of fluid and electrolytes, often with nutrients.
What do those with shortened small intestine with terminal small bowel stoma need to manage sodium and fluid losses?
- Increased salt intake
- Restriction of hypotonic fluids between meals
- Oral glucose-electrolyte mixture
What is Whipple’s Disease?
A rare infection caused by trophyeryma whipplei
