GI: Conditions of the small intestine

Question 1

What is the role of the small intestine?

Answer 1

To digest and absorb nutrients

Question 2

What are the symptoms of small bowel disease?

Answer 2

Diarrhoea 
Steatorrhoea 
Abdominal pain/distension 
Anorexia
Weight loss

Question 3

What are the most common disorders of the small intestine that cause malabsorption?

Answer 3

Coeliac’s disease

Crohn’s disease

Question 4

What investigations are indicated in a patient with small bowel disease symptoms and/or folate deficiency/vitamin B12 deficiency?

Answer 4

First line: Coeliac serology (tTG antibodies)
Small bowel barium follow through
Endoscopic small bowel biopsy

Question 5

What is coeliac disease?

Answer 5

An autoimmune sensitivity to gluten

Associated with HLA DQ2 in 95% of people

Question 6

What is the toxic portion of the gluten molecule?

Answer 6

Alpha-gliadin

Question 7

What histological findings are characteristic of coeliac disease?

Answer 7

Abnormal jejunal mucosa
Villous atrophy
Crypt hyperplasia

Question 8

What two age groups does coeliac disease present in?

Answer 8

Infancy

Adults in their 50s

Question 9

What signs + symptoms might a patient with coeliac disease present with?

Answer 9

Small bowel disease symptoms (typically diarrhoea and weight loss)
or
Symptoms may be non specific (malaise/fatigue)

Physical signs related to anaemia/malnutrition: angular cheillitis + apthous ulcers

Question 10

Which patients should be offered coeliac serology testing?

Answer 10

Patients with:
A first degree relative affected by the disease
Type 1 diabetes
Thyroid disease 
Autoimmune liver disease
Down's syndrome 
IBS

Question 11

What is the first-line investigation for coeliac disease?

Answer 11

Serology: anti-tTG antibodies

Question 12

How is coeliac disease diagnosed?

Answer 12

Duodenal biopsy

Question 13

What other investigation is performed at the diagnosis of coeliac disease?

Answer 13

Bone densitometry due to increased risk of osteoporosis

Question 14

Which vaccine is given in coeliac disease?

Answer 14

Pneumococcal vaccine due to association of hyposplenism (reduced spleen function)

Question 15

What is dermatitis herpetiformis?

Answer 15

An itchy, symmetrical rash that indicates underlying coeliac disease

Question 16

How is dermatitis herpetifromis diagnosed?

Answer 16

Skin biopsy + serology for ETG antibodies

Question 17

How is dermatitis herpetiformis treated?

Answer 17

Dapsone (antibiotic) + gluten free diet

Question 18

What is whipple’s disease?

Answer 18

A rare, bacterial infection of the small bowel

Question 19

What are the symptoms of whipple’s disease?

Answer 19

Steatorrhoea
Abdominal pain 
fever
arthritis 
Lymphadenopathy

Question 20

What sign is seen on biopsy for Whipple’s disease?

Answer 20

Acid Schiff positive macrophages

Question 21

How is whipple’s disease treated?

Answer 21

Co-trimoxazole for 1 year

Question 22

Reactivation of primary TB can affect which part of the GI tract?

Answer 22

Ileocaecal valve

Question 23

What are the common causes of mesenteric ishaemia?

Answer 23

Atherosclerosis

Thromboembolism

Question 24

What is the main symptom of mesenteric ishaemia?

Answer 24

Cramping abdominal pain

Question 25

How is mesenteric ishaemia diagnosed?

Answer 25

Angiography

Question 26

How is mesenteric ishaemia treated?

Answer 26

Urgent surgery

Question 27

How do tumours of the small intestine present?

Answer 27

Abdominal pain Diarrhoea anorexia weight loss

Question 28

Are primary or secondary tumours of the small bowel more common?

Answer 28

Secondary- primary tumours are rare

Question 29

What is the most common malignant tumour of the small bowel?

Answer 29

Adenocarcinoma

Question 30

What cells does a lymphoma arise from?

Answer 30

T and B cells | Increased incidence in coeliac and crohn's patients

Question 31

What cells does a carcinoid tumour arise from?

Answer 31

Enterocromaffin cells

Question 32

What is gallstone ileus?

Answer 32

When a large gallstone migrates via fistulas into the small intestine and becomes lodged

Question 33

What is the name of the most common fistula between the gall bladder and small intestine?

Answer 33

Cholecystoduodenal fistula

Question 34

What are the symptoms of small bowel obstruction?

Answer 34

``` Colicky abdominal pain Absolute constipation (no passing of gas) Abdominal distension Faeculent vomiting ```

Question 35

What is the buzz word for small bowel obstruction?

Answer 35

Tinkling bowel sounds

Question 36

What can cause small bowel obstruction?

Answer 36

Adhesions from previous surgery Crohn's disease (narrowing due to inflammation + scarring) Tumours Hernias

Question 37

What investigations are done in suspected bowel obstruction?

Answer 37

AXR Contrast Abdo CT FBC Urine analysis

Question 38

How is small bowel obstruction managed?

Answer 38

'Drip and Suck' - NG tube drain + IV fluids and potassium

Question 39

Is surgery indicated in small bowel obstruction?

Answer 39

Most cases settle without surgical intervention | ONLY indicated if there is risk of strangulation, perforation or ischaemia

Question 40

Which histological part of the bowel is most sensitive to hypoxia?

Answer 40

The mucosa as it is most metabolically active