Small Intestinal Disease

Question 1

What are the barrier functions of the small intestine?

Answer 1

Immune sampling
Monitoring the presence of pathogens
Translocation of bacteria
GALT

Question 2

What is GALT?

Answer 2

Gut associated lymphoid tissue

Question 3

What elements cause the lumen of the small intestine to be toxic?

Answer 3

Digestive enzymes
Bile salts
IgA presence

Question 4

How are proteins broken down in digestion?

Answer 4

Breakdown to oligopeptides and AAs
Trypsin, chymotrypsin
Hydrolysis at brush border

Question 5

What are the symptoms of small bowel disorder?

Answer 5

Weight loss
Increased appetite
Diarrhoea
Bloating
Fatigue

Question 6

How does diarrhoea present in small bowel disorder?

Answer 6

Watery

Sometimes steatorrhoea

Question 7

What causes steatorrhoea?

Answer 7

Fat malabsorption

High fat content stool

Question 8

What are the signs of small bowel disorder?

Answer 8

Weight loss

Falling/low BMI

Question 9

What are the signs of Ca, Mg and Vit D deficiency?

Answer 9

Tetany

Osteomalacia

Question 10

What is the sign of vitamin A deficiency?

Answer 10

Night blindness

Question 11

What is the sign of vitamin K deficiency?

Answer 11

Raised Proton transfer reaction

Question 12

What is the sign of thiamine (B1) deficiency?

Answer 12

Memory loss

Dementia

Question 13

What is the sign of Niacin (B3) deficiency?

Answer 13

Dermatitis

Unexplained Heart Failure

Question 14

What is the sign of vitamin C deficiency?

Answer 14

Scurvy

Question 15

Scleroderma is suggestive of what?

Answer 15

Systemic sclerosis

Question 16

Aphthous ulceration is suggestive of what?

Answer 16

(mouth ulcer)
Coeliac
Crohns

Question 17

What is dermatitis herpetiformis?

Answer 17

Cutaneous manifestation of Coeliac disease

Question 18

How does dermatitis herpetiformis present?

Answer 18

Itchy, blistering IgA deposits in skin

Scalp, shoulders, elbows, knees

Question 19

What investigations can be used to test the structure of the small bowel?

Answer 19

Biopsy
Meal study
CT Scan
MRI/capsule enterography

Question 20

How can bacterial overgrowth of the small bowel be tested?

Answer 20

H2 breath test

Duodenal/jejunal aspirate culture

Question 21

How is a Bacterial overgrowth breath test performed?

Answer 21

Lactulose or glucose substrate peaking in breath just after consumption

Question 22

Why is Coeliac serology not 100% useful in a coeliac diagnosis?

Answer 22

Whilst IgA is more useful than IgG, not all patients actually make IgA (higher in Coeliacs patients)

Question 23

What must also be tested in combination with IgA TTG?

Answer 23

Plasma IgA levels

Question 24

How is a Coeliac disease diagnosis confirmed?

Answer 24

Positive serology
HLA status
Distal duodenal biopsy

Question 25

What Coeliac-positive result is observed in a duodenal biopsy?

Answer 25

Villous atrophy | partial, subtotal or total

Question 26

Coeliac-positive patients will likely present with which HLA haplotypes?

Answer 26

DQ2 or DQ8

Question 27

Coeliac disease patients are allergic to which fraction of gluten?

Answer 27

Gliadin

Question 28

Why must you be careful of when diagnosing Coeliac disease?

Answer 28

It can mask other diseases

Question 29

What factors are looked for in coeliac serology?

Answer 29

Anti endomysial IgA | Anti Tissue transglutaminease

Question 30

How is Coeliac's disease treated?

Answer 30

Stop eating Gluten | Refer to dietician

Question 31

What is refractory coeliac disease?

Answer 31

Coeliac disease symptoms in patients on a gluten free diet (common in later age)

Question 32

What are common complications of Coeliac's disease?

Answer 32

Refractory Coeliacs disease | Cancers

Question 33

Which inflammatory bowel diseases cause malabsorption?

Answer 33

Coeliac disease | Crohns disease

Question 34

Which infective bowel disease causes malabsorption?

Answer 34

Tropical sprue HIV Gardia lamblia

Question 35

What does tropical sprue cause?

Answer 35

Folate (B9) deficiency

Question 36

What is Gardia lamblia?

Answer 36

Waterborne Unicellular parasite

Question 37

Gardia lamblia is more common in patients suffering from what?

Answer 37

Hypogammaglobulinaemia

Question 38

What is the treatment for Gardia lamblia infection?

Answer 38

Metronidazole

Question 39

What does Gardia lamblia infection cause?

Answer 39

Gardiasis

Question 40

Whipple's disease is caused by what?

Answer 40

Tropheryma whippelii

Question 41

What are the symptoms of Whipples disease?

Answer 41

Weight loss Malabsorption Abdominal pain Skin, brain, joint, heart effects

Question 42

Whipple's disease typically effects whom?

Answer 42

Middle aged men

Question 43

Small bowel overgrowth can occur in conditions that effect what?

Answer 43

Motility Gut structure Immunity

Question 44

What is the main test used in small bowel overgrowth?

Answer 44

H2 breath test (unreliable)

Question 45

What treatment is given in small bowel overgrowth?

Answer 45

``` Rotating antibiotics for 2 weeks: Metronidazole Tetracycline Amoxycillin Vit/nutritional supplements ```