Small Intestine Flashcards by Sasha Murdoch

What are the 3 mechanisms of malabsorption

Structural disorder
Mucosal disorder
Abnormal luminal digestion

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What are the general clinical features of malabsorption

Malaise
Anorexia 
abdominal bloating
diarrhoea 
weight loos

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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)

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What are the 3 aims of investigating malabsorption

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

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What is short bowel syndrome

This is typically when there is

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When does short bowel syndrome occur

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

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

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

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What is the short term management of SBS

Correct malnutrition

Reduce gut secretions (PPI, codeine, loperamide)

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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

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What is Ceoliac disease

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

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What is the main toxic antigenic component of fluten

Alpha - gliadin

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What does the protein in gluten cause

A T cell mediated inflammatory response of the small bowel

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What is the prevalence of Coeliac disease in the UK

1:200

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What are clinical features of Coeliac disease

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

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What is Coeliac disease linked to

HLA-DQ2

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What is coeliac disease often linked to

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

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What are the investigations to confirm the fiagnosis

Duodenal biopsy is GOLD STANDARD

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

Villous atrophy
Crypt hyperplasia
Intraepithelial lymphocytosis

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What antibody needs to be tested for in Coeliac disease

IgA antibodies to Tissue transglutaminase (TTG)

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Why might a patient get a false negative result for IgA

IgA deficiency

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What should be tested when investigating the consequences of Coeliac disease

FBC and blood film
Haematinincs
Clotting screen
Bone investigation

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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

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What is tropical sprue

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

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Who does tropical spruce normally affect

Residents of tropical countries (not travellers)

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What are 2 common symptoms of tropical sprue

Diarrhoea and abdominal distension

What is the treatment for Tropical sprue

Longterm tetracycline and folic acid

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)

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

Jejunal aspirate | Hydrogen breath test after ingesting glucose or lactulose

How is the cause of small intestinal bacterial overgrowth investigated

Small bowel radiology (identifies structural or communication abnormalities )

What is a complication of Small intestinal bacterial overgrowth investigated

Low B12 and normal folate

What 3 things are required in the management of small intestinal bacterial overgrowth

Antibiotics directed towards colonic flora Replace vitamin B12 Definiteive treatment if poosible - surgery or prokinetics

What is bile acid malabsorption characterised by

Postprandial diarrhoea due to osmotic effect of bile salts in the colon or steatorrhoea

If bile acid malabsorption is a secondary abnormality, what is it most commonly due to

Crohn's disease ileal resection intestinal failure

What is teh treatment for bile acid malabsorption

Cholestyramine - a bile acid sequestrant

What is Whipple's disease

A rare disease characterised by malabsorption, finger clubbing, fevers, skin pigmentation, seronegative large-joint arthropathy

How is the diagnosis of Whipple's disease established

By identifying foamy fmacrophagses which stain positive with periodic acid-Schniff on jejunal biopsy

What is the treatment for Whipple's disease

Cotrimoxazole or tetracycline for 1 year

What is protein-losing enteropathy

Gut loss of protein sufficient to reduce serum albumin

How common are small intestine tumours

Very rare - account for

What are the 2 important types of small intestine tumours

Carcinoid and lymphoma

Describe carcinoid tumours

Slow growing and arise from the appendix, small intestine or rectum

When does carcinoid syndrome occur

Only if the tumour metastasises

What is carcinoid syndrome caused by

Systemic release of serotonn, prostaglandins and bradykinins

How are carcinoid tumours diagnosed

By measuring urinary 5-HIAA

What is the treatment for carcinoid tumours

Surgical resection

What are 3 main presentations of carcinoid syndrome

Wheezing Flushing Diarrhoea

What is the diagnostic test for lymphoma

Abdominal CT

What is the treatment of choice for lymphoma

Surgical resection

What is immunoproliferative small intestinal disease

A rare condition also known as alpha heavy chain disease

Who does immunoproliferative small intestinal disease normally affect

Mediterranean and Arab races

How do patients with immunoproliferative small intestinal disease typically present

With diarrhoea malabsorption clubbing weight loss

What shows the alpha heavy chains in immunoproliferative small intestinal disease

Serum electrophoresis

What is the treatment for immunoproliferative small intestinal disease

Long term antibiotics | Only some need chemotherapy

What is more common: single polyp or multiple polyps

Multiple polyps

What are the 3 types of multiple polyps

Nodular lymphoid hyperplasia Hamartomas Andeomatous

What is chronic intestinal pseudo-obstruction

Refers to a dpectrum of rare disorders characterised by the signs and symptoms of intestinal obstruction in the absence of true obstruction

What is required to determine the diagnosis of chronic intestinal pseudoobstruction

Radiological demonstation of a dilated proximal small bowel

What is Meckel's diverticulum

The commonest congenital gut abnormality resulting from failure to close the vitelline duct

If a patient is symptomatic with Meckel's diverticulum, at what age would they present?

Before the age of 2

Males are twice as likely to be affected. True or False

True

What are the classic symptoms of Meckel's diverticulum

Painless melaena with intestinal obstruction or intussusception being rare

How is Meckel's diverticulum diagnosed

Using a Meckel's scan - injecting a radioisotope which is taken up by ectopic parietal cells

Who is most likely to have hypolactasia

Africans and Asians

What might secondary causes of lactase deficiency result in

Osmotic diarrhoea, abdominal pain borborygmi after eating milk products Flatulence

How is diagnosis of lactase deficiency made

Using a lactose substrate hydrogen breath test

What is the treatment for lactase deficiency

Minimising milk products

In food allergy, what type of hypersensitivity reaction occurs

Type 1

What is the treatment for food allergy

Dietary avoidance

Small Intestine Flashcards

(68 cards)