What is Coeliac Disease?
This is an autoimmune inflammatory reaction to Giladin (which is within Gluten).
It causes Villous Atrophy and Malabsorption
Which gene codes for the human leukocyte antigen found on THelper Cells, that is strongly associated with coeliac disease?
Which enzyme, found in enterocytes, breaks down gliadin to glutamic acid?
Which region of the bowel is most affected by Coeliac disease?
Proximal SI (especially duodenum)
What are the symptoms of Coeliac disease?
- Diarrhoea and abdo pain
- Distension and Flatus
- Mouth ulcers
- weight loss
- Neurological symptoms
Dermatitis Herpetiformis is a skin condition that is present in 20% of patients with which disease?
What are the symptoms of B12 deficiency?
- Tired and light-hearted
- Neurological effects (pins and needles/unsteadiness)of B12 deficiency
Vitiligo is an autoimmune condition associated with which type of anaemia?
Pernicious anaemia (Vit B12 deficiency)
What is pathogenesis of Pernicious anaemia?
Autoantibodies (anti-parietal cell antibodies or anti-intrinsic factor antibodies) destroy parietal cells
/intrinsic factor in gastric body. Results in IF deficiency and also achlorhydria.
In Glucose-Galactose malabsorption, which sugar is absorbed normally?
Where are parietal cells found? What do they release?
- These cells are found in the body/corpus of the stomach
- HCL - Kill bacteria
Intrinsic Factor (IF)
- Required for the absorption of Vitamin B12
In the Duodenum, Chyme is mized with bile to form ____.
Which important element is absorbed in the Duodenum?
Also, Calcium, Magnesium, and Zinc.
What is the role of the Liver?
Digestion - bile salts act on fats to form micelles
Detox and elimination - from both portal and systemic circulation
Manufactures sugars, proteins (inc. albumin and clotting factors)
Storage of Glycogen
The Pancreas is both an exocrine and an endocrine organ. What happens if it's exocrine function is disrupted?
- "creon" produced by the Pancreas contains lipases, proteases and amylases.
- Will lead to multiple nutrient deficiencies.
- LOSS OF LIPASES RESULTS IN FLOATING, SMELLY, GREASY, STEATORRHOEA
What do the Duct cells of the Pancreas produce?
Which cells of the pancreas produce pancreatic enzymes for the breakdown of macronutrients?
The Jejenum is important for the absorbtion of which things?
- Some fat soluble vitamins ADEK
- Water + Water soluble vitamins
- Ca, minerals, trace elements
What is absorbed in the Proximal Ileum?
- Fats and fat soluble vitamins (ADEK)
- Water and water soluble vitamins
What is absorbed in the Distal Ileum?
- Bile salts
- Intrinsic Factor/Vitamin B12 complex
What does the Ileo-caecal valve regulate?
- Rregulates fat and bile absorption
- Prevents bacterial contamination of ileum
What does the colon absorb?
Short chain FAs: acetate, propionate, and butyrate (produced from microbial fermentation of dietary fibre)
Where is Cholecystokinin secreted from, and what is it's target organ(s) and action?
Target organ(s) and action(s):
- Pancreas - Increased enzyme secretions
- Gallbladder - Contraction
Where is Gastrin produced. Which organ(s) does it effect - and how?
- G cells of Gastric Antrum
Target organ(s) and Action(s);
- Parietal cells in the gastric body - H+ secretion
Where is Gastrin Releasing Hormone produced? Which organ(s) does it affect, and how?
- Vagal nerves cause this release
- They target G cells in the Gastric antrum: They cause gastrin release.
Where is Glucagon produced from? Which organ(s) does it affect, and how?
- Islets of langerhans in pancreas
- Liver. Increases production of glucose and breakdown of glycogen.
Where is Guanylin produced? Which organ(s) does it affect, and how?
- Small intestine and large intestine: Fluid absorption
Where is Somatostatin produced? Which organs does it affect and how?
- D cells of the stomach and duodenum]
- Gamma cells of pancreatic ileus
- Stomach - Decreased Gastrin
- Intestine - < fluid absorption, > secretion
- Pancreas - Decrease endo and exocrine secretions
- Liver - Decrease bile flow
Where is vasoactive intestinal peptide produced? Which organ(s) does it affect, and how?
- ENS Neurons (Enteric nervoous system)
- Small intenstine and pancreas: Increased secretions
- Small intestine: Relaxes smooth muscle
Which 4 things do you need to digest and absorb fats?
- Bile salts
- Pancreatic lipase
- Ileum (absorption)
- Terminal ileum: bile salt absorption
What are the symptoms of Vitamin A deficiency?
- Night blindness
- Benign Intracranial hypertension
What are the symptoms of Vitamin Deficiency?
What are the symptoms of Vitamin E Deficiency?
- Peripheral neuropathy/ataxia/opthalmoplegia
What are the symptoms of Vitamin K deficiency?
- Coagulopathy - Prolonged PT
If you have a problem with absorption of Fat soluble vitamins, (AKED), you will have a problem with clotting.
- Vitamin K effects clotting factors 2, 9, 7 and 10.
Vitamin K affects which clotting factors?
2, 7 , 9 , 10
An infant delivered at 26/40 developed
necrotising enterocolitis (NEC). At
surgery, most of the ileum including the
ileo-caecal valve was non-viable and
was excised. An ileo-colonic
anastomosis was fashioned.
At the age of 2 years, the child eats well but
is underweight and passes 10 liquid
Give 4 possible reasons for the Diarrhoea.
a.) A likely cause of diarrhoea is bacterial overgrowth of
the small intestine (SI). The SI is usually almost
sterile. However, excision of the ileo-caecal valve
allows bacteria from the large intestine (LI) to invade
the SI. This results in mucosal inflammation and
b) Bile salts that should have been absorbed in the
terminal ileum (TI) may irritate the colonic mucosa
and cause watery diarrhoea.
c) Bile salt deficiency (again resulting from loss of the
TI) may result in fat malabsorption, causing
steatorrhoea. More details of the nature of the liquid
stools would help to identify this.
d) Gut resection will have reduced the mucosal surface
area for nutrient absorption–resulting in
malabsorption. However, in practice, if the jejunum
remains intact and is healthy, this should be sufficient for absorption of nutrients that are absorbed in the proximal SI.
e) There are multiple other causes (blind loop,
With a patient that has an entire ileo-jejunal resection (including ileo-caecal valve) - what medications would be regularly required?
- Fat soluble vitamins ADEK
- Try loperamide (cautiously)
Microcytic, hypochromic anaemia is associated with deficiency of what?
Low serum ferritin is a sign of absence of what?
Transaminitis is associated with what?
Associated with coeliac disease
Raised Alk. Phos. may be normal in growing children - may aso indicate which pathology?
Osteomalacia (Vitamin D malabsorption)
What is selective IgA deficiency associated with?
Coeliac disease and other autoimmune conditions
Other than Villous hyperplasia, what histologically features of Coeliac disease are there?