Small Intestine Flashcards Preview

Gastrointestinal (LECTURE NOTES) > Small Intestine > Flashcards

Flashcards in Small Intestine Deck (68)
Loading flashcards...
1

What are the 3 mechanisms of malabsorption

Structural disorder
Mucosal disorder
Abnormal luminal digestion

2

What are the general clinical features of malabsorption

Malaise
Anorexia
abdominal bloating
diarrhoea
weight loos

3

What are some specific clinical features of malabsorption

Steatorrhoea (fat malabsorption)
Oedema ascites (protein malabsorption)
Skin rash (Zn or Vit B malabsorption)
Cheilitis, glossitis (vitamin B malabsorption)
Neuropathy, psychological effects (vit B12 malabsorption)
Night blindness (vit A malabsorption)
Bruising (vit K or vit C malabsorption)
Bone pain, myopathy, oesteoporosis (vit D malabsorption)

4

What are the 3 aims of investigating malabsorption

To establish the condition
To identify the site of abnormality
To identify the severity

5

What is short bowel syndrome

This is typically when there is

6

When does short bowel syndrome occur

When there is insufficient functioning small intestine to allow normal digestion and absorption

7

What are some causes of short bowel syndrome (intestinal failure)

Extensive surgery
Crohn's disease
Mesenteric ischaemia
Radiation damage
Volvulus
Congenital abnormalities in children

8

What is the short term management of SBS

Correct malnutrition
Reduce gut secretions (PPI, codeine, loperamide)

9

What is the long term management of SBS

Monitor nutrition and ensure adequate calorie intake
Monitor hydration status
Replace vitamins and mineral
Reduce gut secretions
Treat small intestinal bacterial overgrowth
Cholecystectomy if gallstones develop
Small bowel transplantation

10

What is Ceoliac disease

An immune mediated disorder resulting in small intestinal villous atrophy which resolves on gluten withdrawal from the diet

11

What is the main toxic antigenic component of fluten

Alpha - gliadin

12

What does the protein in gluten cause

A T cell mediated inflammatory response of the small bowel

13

What is the prevalence of Coeliac disease in the UK

1:200

14

What are clinical features of Coeliac disease

Failure to thrive at weaning time (infants)
Abdominal pain / bloating
Lethargy
Anaemia
Diarrhoea or constipation

15

What is Coeliac disease linked to

HLA-DQ2

16

What is coeliac disease often linked to

Other autoimmune diseases such as dematitis herpetiformis, insulin dependent diabetes, thyroid disease, primary biliary cirrhosis

17

What are the investigations to confirm the fiagnosis

Duodenal biopsy is GOLD STANDARD

18

What would be seen on a duodenum biopsy in someone with Coeliac disease

Villous atrophy
Crypt hyperplasia
Intraepithelial lymphocytosis

19

What antibody needs to be tested for in Coeliac disease

IgA antibodies to Tissue transglutaminase (TTG)

20

Why might a patient get a false negative result for IgA

IgA deficiency

21

What should be tested when investigating the consequences of Coeliac disease

FBC and blood film
Haematinincs
Clotting screen
Bone investigation

22

What is the management for Coeliac Disease

Life long gluten-free diet to prevent the ongoing antigen provocation of the inflammatory response
Correct deificencies
Aggressive management of any bone disease

23

What is tropical sprue

A rare condition associated with small intestine villous atrophy and is thought to be post-infectious.

24

Who does tropical spruce normally affect

Residents of tropical countries (not travellers)

25

What are 2 common symptoms of tropical sprue

Diarrhoea and abdominal distension

26

What is the treatment for Tropical sprue

Longterm tetracycline and folic acid

27

What 3 things does colonisation of the small intestine by colonic flora result in

Deconjugating bile salts (diarrhoea)
Metabolising vitamin B12 (anaemia)
Metabolising carbohydrate (resulting in calorie malnutrition and halitosis)

28

What 2 investigations are carried out for the condition of small intestinal bacterial overgrowth?

Jejunal aspirate
Hydrogen breath test after ingesting glucose or lactulose

29

How is the cause of small intestinal bacterial overgrowth investigated

Small bowel radiology (identifies structural or communication abnormalities )

30

What is a complication of Small intestinal bacterial overgrowth investigated

Low B12 and normal folate