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Systems: Alimentary AB > Small Intestinal Disorders and Investigations > Flashcards

Small Intestinal Disorders and Investigations Flashcards

(55 cards)

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1
Q

What are the functions of the small intestine?

A
  • Digestion
  • Absorption
  • Endocrine and neuronal control functions
  • Barrier functions
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2
Q

Digestion

A

The breaking of food into its components

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3
Q

Absorption

A

The passage of nutrients into the body

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4
Q

Endocrine and neuronal control functions

A

Controlling the flow of material from the stomach to the colon

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5
Q

Barrier functions

A
  • Regulating what stays in and gets out

- Maintaining a barrier against pathogens

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6
Q

How does the small intestine maintain a barrier against pathogens?

A
  • Immune sampling
  • Monitoring the presence of pathogens
  • Translocation of bacteria
  • Gut associated lymphoid tissue GALT
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7
Q

What is the average length of the small intestine by age 11?

A

250-450cm

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8
Q

How is a large surface area of the small intestine maintained?

A
  • Villous architecture

- Constant turnover of cells in crypts and villi

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9
Q

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

A

Toxic environment

  • Digestive enzymes
  • Bile salts
  • Presence of IgA
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10
Q

How is control of digestion maintained?

A
  • Decontamination of dirty food
  • Requires a lot of fluid
  • Controlled by hydrolysis to avoid fluid shifts
  • Sophisticated control of motility
  • Absorption against gradients
  • Onward processing in the liver
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11
Q

What does the commencement of digestion in the stomach involve?

A
  • Salivary amylase
  • Pepsin
  • Controlled breakdown to avoid osmotic shifts
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12
Q

Describe the basic digestion of proteins.

A
  • Breakdown to ogliopeptides and amino acids
  • Trypsin
  • Final hydrolysis and absorption at brush border
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13
Q

Describe the basic digestion of fat.

A
  • Pancreatic lipase

- Absorption of glycerol and free fatty acids via lacteal and lymphatic system

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14
Q

Describe the basic digestion of carbohydrates.

A
  • Pancreatic amylase
  • Breakdown to disaccharides
  • Final digestion by brush border disaccharides
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15
Q

Symptoms of malabsorption

A
  • Weight loss
  • Increased appetite
  • Bloating
  • Fatigue
  • Diarrhoea
  • Steatorrhoea
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16
Q

Steatorrhoea

A
  • Stool that is pale, foul smelling and high in fat content
  • Due to fat malabsorption
  • Stool less dense and floats
  • May leave an oily mark
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17
Q

Signs of malabsorption

A
  • Signs of weight loss

- Low or falling BMI

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18
Q

Signs of iron deficiency

A
  • Anaemia

- Sore tongue

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19
Q

Signs of Ca, Mg and vitamin D deficiency

A
  • Tetany

- Osteomalacia

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20
Q

Signs of vitamin A deficiency

A

Night blindness

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21
Q

Signs of vitamin K deficiency

A

Raised PTR

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22
Q

Signs of vitamin C deficiency

A

Scurvy

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23
Q

Signs of vitamin B complex deficiency

Study These Flashcards
A
  • Thiamine (memory, dementia)

- Niacin (dermatitis, unexplained heart failure)

24
Q

What can clubbing be a non-specific sign of?

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A
  • Coeliac disease

- Crohn’s

25
What can scleroderma be a non-specific sign of?
-Systemic sclerosis
26
What can aphthous ulceration be a non-specific sign of?
- Coeliac disease | - Crohn's
27
Dermatitis herpetiformis
Cutaneous manifestation of coeliac disease
28
How does dermatitis herpetiformis appear?
- Blistering - Intensely itchy - Scalp, shoulders, elbows, knees - IgA deposit in skin
29
What investigations are there that test the structure of the GIT?
- Small bowel biopsy via endoscopy - Small bowel study using barium - White cell scan - CT - MRI enterography - Capsule enterography
30
What tests can detect bacterial overgrowth?
- H2 breath test (lactulose or glucose substrate) | - Culture a duodenal or jejunal aspirate
31
Why is IgA sometimes less reliable than IgG as a test for coeliac disease?
A significant number of people don't make IgA in the first place
32
Why should the total plasma IgA be checked?
Selective IgA deficiency is relatively common about 0.1-1% of the population but 2-3% of coeliacs
33
What tests can be used to diagnose coeliac disease?
- Distal duodenal biopsy (villous atrophy) | - HLA status
34
What is the prevalence of coeliac disease?
- 1:111 in UK | - 1:300 clinical diagnosis
35
What is coeliac disease a sensitivity to?
Gliadin fraction of Gluten
36
Where is gliadin found?
- Wheat - Rye - Barley
37
What is the pathology behind coeliac disease?
- Produces an inflammatory response thought to be via tissue transglutaminase - Partial or subtotal villous atrophy - Increased intra-epithelial lymphocytes
38
What is the gold standard diagnostic test for coeliac disease?
Distal duodenal biopsy
39
What serology is looked for in coeliac disease?
- Anti- endomysial IgA - Anti Tissue transglutaminase - Anti gliadin may help in children but not diagnostic in adults
40
What is the treatment for coeliac disease?
- Withdraw gluten | - Referral to state registered dietician
41
What conditions are associated with coeliac disease?
- Dermatitis herpetiformis - IDDM - Autoimmune thyroid disease - Autoimmune hepatitis - Primary biliary cirrhosis - Autoimmune gastritis - Sjogren syndrome - IgA deficiency - Downs syndrome
42
What complications can there be with coeliac disease?
- Refractory coeliac disease - Small bowel lymphoma - Oesophageal carcinoma - Colon cancer - Small bowel adenocarcinoma
43
What inflammatory causes of malabsorption are there?
- Coeliac disease | - Crohn's
44
What infectious causes of malabsorption are there?
- Tropical sprue - HIV - Giardia lamblia
45
Tropical sprue
Folate deficiency which responds to antibiotics
46
Giardia lamblia
Unicellular parasite found in contaminated water that can cause hypogammglobulinaemia and responds to metronidazole
47
What can Whipples disease cause?
- Skin, brain, joints and cardiac effects - Weight loss - Malabsoprtion - Abdominal pain - PAS material in villi
48
Who is usually affected by Whipples disease?
Middle aged men
49
What organism is responsible for Whipples disease
Tropheryma whippelli
50
What infiltrative causes of malabsorption are there?
Amyloid
51
What impaired motility causes of malabsorption are there?
- Systemic sclerosis - Diabetes - Pseudo obstruction
52
What iatrogenic causes of malabsorption are there?
- Gastric surgery - Short bowel syndrome - Radiation
53
What pancreatic causes of malabsorption are there?
- Chronic pancreatitis | - Cystic fibrosis
54
Small bowel overgrowth can occur in any condition that affects...
- Motility - Gut structure - Immunity
55
How should bacterial overgrowth be treated?
Rotating antibiotics, each for 2 weeks - Metronidazole - Tetracylcine - Amoxycillin Vitamin and nutritional supplements

Systems: Alimentary AB (37 decks)

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