Malabsorbtion and Small Intestinal Disease

Question 1

what are four general functions of the small intestine?

Answer 1

> digestion
absorption
endocrine/neural functions
barrier to outside

Question 2

how does the small intestine act as a barrier?

Answer 2

> immune sampling, bacteria pulled through the wall intact then smashed up by white blood cells that review their antigens
monitoring pathogen presence
translocation of bacteria
gut associated lymphoid tissue

Question 3

why is breakdown controlled in the stomach?

Answer 3

to avoid osmotic shifts

Question 4

where does protein digestion begin?

Answer 4

the small intestine

Question 5

what system are glycerol and free fatty acids transported through within the body?

Answer 5

the lacteal and lymphatic system

Question 6

what symptoms are seen with small intestinal disorders?

Answer 6

> weight loss
> increased appetite
> diarrhoea
> bloating
> fatigue (v. vague)
> Steatorrhoea

Question 7

how may patients describe steatorrhea (not the clinical definition but what patients may actually describe)?

Answer 7

> foul smell

> orange oil that floats

Question 8

what signs are associated with small intestinal disorders?

Answer 8

falling/low BMI

Question 9

what signs may specifically accompany calcium, magnesium and vitamin d deficiency?

Answer 9

> tetany (spasming/twitching of muscles)

> osteomalacia

Question 10

what may vit. a deficiency cause?

Answer 10

night blindness

Question 11

what are the signs of vit. k deficiency?

Answer 11

raised PT (prothrombin time)

Question 12

what are signs of vit b complex deficiencies?

Answer 12

> thiamine: dementia

> niacin: dermatitis, unexplained heart failure

Question 13

what are signs of vit. c deficiency?

Answer 13

scurvy

Question 14

what conditions may cause clubbing?

Answer 14

coeliac or crohns

Question 15

what may be causing sclerodoma?

Answer 15

systemic sclerosis

Question 16

what is aphthous ulceration a general sign of?

Answer 16

coeliac and crohns

Question 17

describe dermatitis herpetiforms

Answer 17

> cutaneous manifestation of coeliac disease
> blistering
> intense itching
> scalp, shoulders, elbows, knees
> IgA deposit in skin

Question 18

name some tests of the structure of the small bowel

Answer 18

> small bowel biopsy (endoscopy)
> small bowel study (barium swallow)
> white cell scan
> CT scan
> MRI enterography
>capsule enterography

Question 19

how may you measure bacterial overgrowth?

Answer 19

> h2 breath test (lactulose/glucose substrate)

> culture of duodenal jejunal aspirate

Question 20

in a distal duodenal biopsy what three levels of villus atrophy are there?

Answer 20

> partial
subtotal
total

Question 21

what are coeliacs sensitive to in wheat, rye and barley?

Answer 21

gliadin fraction of gluten

Question 22

from what is gliadin absent?

Answer 22

rice and maize and oats (oats are mostly contaminated with wheat anyway due to farming methods)

Question 23

describe the pathology of coeliac’s disease

Answer 23

> inflammatory response (tissue transglutaminase)
partial/subtotal villus atrophy
increased intra-epithelial lymphocytes

Question 24

what test would you use to diagnose coeliac’s?

Answer 24

distal duodenal biopsy

Question 25

what serology is used to diagnose coeliac's?

Answer 25

> anti endomysial IGA > anti tissue transglutaminase > anti-gliadin is useful in children but not adults

Question 26

what is the treatment for coeliac disease?

Answer 26

> withdraw gluten > refer to state registered dietitian > coeliac support group

Question 27

what conditions are associated with coeliacs?

Answer 27

``` > Dermatitis herpetiformis > IDDM > Autoimmune thyroid disease > Autoimmune hepatitis > Primary Biliary cirrhosis > Autoimmune gastritis > Sjogren syndrome > IgA deficiency > Downs Syndrome ```

Question 28

what complications are associated with coeliacs?

Answer 28

``` > refractory coeliac disease > small bowel lymphoma > oesophageal carcinoma > colon cancer > small bowel adenocarcinoma ```

Question 29

what inflammatory problems lead to malabsorption?

Answer 29

> coeliac disease | > crohns

Question 30

what infections lead to malabsorption?

Answer 30

> tropical sprue > HIV > giardia lamblia

Question 31

describe giardia lamblia

Answer 31

> unicellular parasite found in contaminated water | > responds to metronidazole

Question 32

what causes malabsorption?

Answer 32

``` > whipples disease ( causative organism is tropheryma whippelii) > infiltration > impaired motility > iatrogenic > pancreatic disease > inflammation > infection ```

Question 33

describe the effects of whipples disease

Answer 33

> skin, brain, joints and cardiac effects > weight loss > abdominal pain > PAS material in the villi

Question 34

What pancreatic conditions can lead to malabsorption?

Answer 34

> Cystic fibrosis | > Chronic pancreatitis

Question 35

What infiltration conditions can lead to malabsorption?

Answer 35

Amyloidosis

Question 36

What conditions which cause impaired motility can result in malabsorption?

Answer 36

> Systemic sclerosis > Diabetes > Pseudo obstruction

Question 37

What are some iatrogenic causes of malabsorption?

Answer 37

> Gastric surgery > Short bowel syndrome > Radiation