Malbsorotion and small intestinal disease

Question 1

What are the functions of the small intestine?

Answer 1

Digestion
Absorption
Endocrine and neuronal control
Barrier against pathogens

Question 2

What are the barrier functions of the small intestine?

Answer 2

Immune sampling
Monitoring of the presence of pathogens
Translocation of bacteria
Gut assocatied lymphoid tissue

Question 3

What is the structure of the small intestine?

Answer 3

250-450cm

Villous architecture

Question 4

Why is there a low bacterial population of the small intestine?

Answer 4

Digestive enzymes
Bile salts
Presence of IgA etc

Question 5

Where does digestion commence?

Answer 5

Stomach

Question 6

What are proteins broken down to?

Answer 6

Oligopeptides and amino acids

Question 7

What happens to digested proteins at the brush border?

Answer 7

Final hydrolysis and absorption

Question 8

What breaks down fats?

Answer 8

Pancreatic lipase

Question 9

What are fats broken down to?

Answer 9

Glycerol and free fatty acids

Question 10

How are glycerol and fatty acids absorbed?

Answer 10

Via lacteals into the lymphatic system

Question 11

What are the causes of malabsorption?

Answer 11

Inflammation
Infection
Infiltration
Impaired motility
Iatrogenic
Pancreatic

Question 12

What are the inflammatory causes of malabsorption?

Answer 12

Coeliac

Crohn’s

Question 13

What are the infective causes of malabsorption?

Answer 13

Tropica sprue
HIV
Giardia lambila
Whipples diseae
Tropheryma whippelii

Question 14

What are the impaired motility causes of malabsorption?

Answer 14

Systemic sclerosis
Disabetes
Pseudo obstruction

Question 15

What are the iatrogenic causes of malabsorption?

Answer 15

Gastric surgery
Short bowel syndrome
Radiation

Question 16

What are the pancreatic causes of malabsorption?

Answer 16

Chronic pancreatitis

Cystic fibrosis

Question 17

What are the symptoms of malabsorption?

Answer 17

Weight loss
Increased appetite
Steatorrhoea

Question 18

What are the characteristics of steatorrhoea?

Answer 18

Stool floats, pale, foul smelling, may leave oily mark

Question 19

What are the signs of malabsorption?

Answer 19

Specific deficiencies
Clubbing
Scleroderma
Aphthous ulceration
Dermatitis herpetiformis

Question 20

What specific deficiencies can arise from malabsorption?

Answer 20

Iron
B12, folate
Ca, Mg, vit A, C, D, K
Vit B complex

Question 21

What does Ca, Mg and vit D deficiency cause?

Answer 21

Tetany

Osteomalacia

Question 22

What does a vit A deficiency cause?

Answer 22

Night blindness

Question 23

What does a vit B complex deficiency cause?

Answer 23

Thiamine deficiency- memory, dementia

Niacin deficiency- dermatitis, unexplained heart failure

Question 24

What i clubbing a sign of?

Answer 24

Crohn’s

coeliac

Question 25

What is aphthous ulceration a sign of?

Answer 25

Crohn's | Coeliac

Question 26

What is the cutaneous manifestation of coeliac?

Answer 26

Dermatitis herpetiformis | IgA deposits in skin

Question 27

What are the forms of small bowel investigation?

Answer 27

Tests of structure Tests of function Other

Question 28

What are the structural tests of the small bowel?

Answer 28

``` Biopsy via endoscopy Barium swallow White cell scan CT MRI enterography Capsule enterography ```

Question 29

What tests can be used to determine bacterial overgrowth?

Answer 29

H2 breath test | Culture of duodenal/jujenal aspirate

Question 30

What is coeliac?

Answer 30

Sensitivity to the gladden fraction of gluten

Question 31

What is gluten found in?

Answer 31

Wheat, rye, barley

Question 32

What is gluten absent from?

Answer 32

Maize, rice, oats

Question 33

What are the symptoms of coeliac?

Answer 33

``` Weight loss Diarrhoea and/or constipation Abdo pain Anaemia Fatigue Bloating Dermatitis herpeformis ```

Question 34

What is the pathology of coeliac?

Answer 34

Produces inflammatory response, causing partial or total villous atrophy and increased epithelial lymphocytes

Question 35

How is coeliac diagnosed?

Answer 35

Serology then if + distal duodenal biopsy

Question 36

Whatvare the 3 levels of villous atrophy?

Answer 36

Partial- villi shortened Subtotal- lining flat but glands extended Total- lining flat

Question 37

What is the treatment of coeliac?

Answer 37

Withdrawal of gluten | Referral o state registered dietician

Question 38

What conditions are associated with coeliac?

Answer 38

``` Demartitis herpetiformis Type 1 diabetes Autoimmune thyroid disease Autoimmune hepatitis Primay biliary cirrhosis Autoimmune gastritis Sjogren syndrome IgA deficiency Downs Syndrome ```

Question 39

What are the possible complications of coeliac?

Answer 39

``` Refractory coeliac disease Small bowel lymphoma Oesophageal carcinoma Colon cancer Small bowel adenocarcinoma ```

Question 40

What is refractory coeliac disease?

Answer 40

Coeliac disease with doesn't respond to diet | Treat with steroids