Malabsorption and small intestinal disease

Question 1

What are the main functions of the small intestine?

Answer 1

Digestion, absorption, endocrine and neural control and barrier functions

Question 2

List 4 ways in which the small intestine acts as a barrier against pathogens

Answer 2

gut associated lymphoid tissue
immune sampling
monitor pathogen presence
translocation of bacteria

Question 3

What is the average adult length of the small intestine and what age is this achieved by?

Answer 3

2.5-4.5m

11 years old

Question 4

What makes up the toxic environment of the small intestine? what is the result of this?

Answer 4

bile salts, IgA, enzymes

low bacterial population

Question 5

Why is digestion controlled?

Answer 5

to avoid osmotic shifts

Question 6

What constituents are proteins broken down to and what enzyme controls this?

Answer 6

oligopeptides and amino acids

trypsin

Question 7

What are the symptoms of malabsorption?

Answer 7

weight loss
increased appetite in severe malabsorption
steatorrhoea

Question 8

Briefly describe steatorrhoea - cause, appearance etc

Answer 8

malabsorption of fat which leads to fat in the faeces giving a very high content of fat in the stool. This results in a less dense, pale, foul smelling stool which floats. Often complaints about leaving an oily mark.

Question 9

What is scleroderma an indicator effect and what can this effect in the gut?

Answer 9

systemic sclerosis

motility

Question 10

What illnesses can clubbing and aphthous ulceration be an indicator of?

Answer 10

crohns and coeliac

Question 11

What is the cutaneous manifestation of coeliac disease called?

Answer 11

dermatitis herpetiforms

Question 12

What is dermatitis herpetiforms like?

Answer 12

intensely itchy found at elbows, knees, shoulders and scalp with blistering

Question 13

What is dermatitis herpetiforms due to?

Answer 13

IgA deposit in the skin

Question 14

Are there more investigations for structure or function of the gut?

Answer 14

structure

Question 15

What are some tests of structure of the small bowel?

Answer 15

endoscopy - biopsy

barium meal, MRI enterography, capsule enterography, CT, white cell scan

Question 16

What test can be done for suspected bacterial overgrowth?

Answer 16

H2 breath test

Question 17

What is villous atrophy associated with?

Answer 17

absorption disruption

Question 18

What is coeliac disease due to?

Answer 18

sensitivity to giadin in gluten

Question 19

What foods is gluten found in?

Answer 19

wheat, barley, rye - not in oats but oats are usually made in contact with the others so are common to be contaminated so coeliacs usually eat special oats

Question 20

An inflammatory response is produced via what antibody in coeliac disease?

Answer 20

tissue transglutaminase

Question 21

List the steps of the pathology behind coeliac disease

Answer 21

After inflammatory response there is also villous atrophy be it partial or subtotal, increased intra epithelial lymphocytes

Question 22

How is coeliac disease diagnosed?

Answer 22

Via distal duodenal biopsy and serology - anti tissue transglutaminase and anti endosymal IgA

Question 23

How is coeliac disease treated?

Answer 23

remove gluten from diet - refer to dietitian

Question 24

List some associated conditions with coeliac disease

Answer 24

autoimmune hepatitis, primary biliary cirrhosis, autoimmune thyroid disease, autoimmune gastritis, downs syndrome, dermatitis herpetiforms

Question 25

List some complications of coeliac disease

Answer 25

small bowel lymphoma, colon cancer, oesophageal cancer, small bowel adenocarcinoma, refractory coeliac disease

Question 26

Inflammatory causes of malabsorption

Answer 26

coeliac disease

crohns

Question 27

Infection causes of malabsorption

Answer 27

tropical sprue
HIV
gardia lambia - parasite found in infected water

Question 28

Pancreatic causes of malabsorption

Answer 28

chronic pancreatitis, cystic fibrosis

Question 29

What is whipples disease?

Answer 29

caused by tropheryma whippeli
effects middle aged men 
weight loss, malabsorption, abdo pain 
skin, brain, joints and cardiac
treated with antibiotics

Question 30

Infiltration causes of malabsorption?

Answer 30

amyloid

Question 31

Impaired motility causes of malabsorption?

Answer 31

systemic sclerosis
diabetes
pseudo obstruction

Question 32

Iatrogenic causes of malabsorption?

Answer 32

radiation
short bowel syndrome
gastric surgery