Week 237 - Malabsorption/Chronic Diarrhoea Flashcards Preview

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Flashcards in Week 237 - Malabsorption/Chronic Diarrhoea Deck (44):
1

Week 237

 

What is Coeliac Disease?

This is an autoimmune inflammatory reaction to Giladin (which is within Gluten).

 

It causes Villous Atrophy and Malabsorption

2

Week 237

 

Which gene codes for the human leukocyte antigen found on THelper Cells, that is strongly associated with coeliac disease?

 

 

HLA-DQ2

3

Week 236

 

Which enzyme, found in enterocytes, breaks down gliadin to glutamic acid?

Tissue Transglutaminase

4

Week 236

 

Which region of the bowel is most affected by Coeliac disease?

Proximal SI (especially duodenum)

5

Week 236

 

What are the symptoms of Coeliac disease?

  • Diarrhoea and abdo pain
  • Steatorrhoea
  • Distension and Flatus
  • Mouth ulcers
  • weight loss
  • Fatigue/Malaise
  • Anaemia
  • Osteopaenia
  • Neurological symptoms

 

6

Week 236

 

Dermatitis Herpetiformis is a skin condition that is present in 20% of patients with which disease?

Coeliac disease.

7

Week 236

 

What are the symptoms of B12 deficiency?

  • Glossitis
  • Tired and light-hearted
  • Neurological effects (pins and needles/unsteadiness)of B12 deficiency

8

Week 236

 

Vitiligo is an autoimmune condition associated with which type of anaemia?

Pernicious anaemia (Vit B12 deficiency)

 

 

9

Week 236

 

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.
 

10

Week 236

 

In Glucose-Galactose malabsorption, which sugar is absorbed normally?

Fructose.

11

Week 236

 

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

12

Week 236

 

In the Duodenum, Chyme is mized with bile to form ____.

Chylomicrons

13

Week 236

 

Which important element is absorbed in the Duodenum?

IRON

 

Also, Calcium, Magnesium, and Zinc.

14

Week 237

 

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

15

Week 236

 

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

16

Week 237

 

What do the Duct cells of the Pancreas produce?

Bicarbonate/water

17

Week 237

 

Which cells of the pancreas produce pancreatic enzymes for the breakdown of macronutrients?

Acinar cells

18

Week 237

 

The Jejenum is important for the absorbtion of which things?

  • Proteins
  • Monosaccharides
  • Some fat soluble vitamins ADEK
  • Water + Water soluble vitamins
  • Folate
  • Ca, minerals, trace elements

 

19

Week 237

 

What is absorbed in the Proximal Ileum?

  • Fats and fat soluble vitamins (ADEK)
  • Water and water soluble vitamins

 

20

Week 237

 

What is absorbed in the Distal Ileum?

  • Bile salts
  • Intrinsic Factor/Vitamin B12 complex

21

Week 237

 

What does the Ileo-caecal valve regulate?

  • Rregulates fat and bile absorption
  • Prevents bacterial contamination of ileum

 

22

Week 237

 

What does the colon absorb?


Water
Electrolytes (minimal)
Short chain FAs: acetate, propionate, and butyrate (produced from microbial fermentation of dietary fibre)

23

Week 237

 

Where is Cholecystokinin secreted from, and what is it's target organ(s) and action?

Secreted from:

  • Duodenum
  • Jejenum
  • Ileum
  • Colon

Target organ(s) and action(s):

  • Pancreas - Increased enzyme secretions
  • Gallbladder - Contraction

24

Week 237

 

Where is Gastrin produced. Which organ(s) does it effect - and how?

Produced in:

  • G cells of Gastric Antrum

Target organ(s) and Action(s);

  • Parietal cells in the gastric body - H+ secretion

25

Week 237

 

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.

26

Week 237

 

Where is Glucagon produced from? Which organ(s) does it affect, and how?

Produced:

  • Islets of langerhans in pancreas

Acts on:

  • Liver. Increases production of glucose and breakdown of glycogen.

27

Week 237

 

Where is Guanylin produced? Which organ(s) does it affect, and how?

Produced:

  • Ileum
  • Colon

Affects:

  • Small intestine and large intestine: Fluid absorption

 

28

Week 237

 

Where is Somatostatin produced? Which organs does it affect and how?

Produced:

  • D cells of the stomach and duodenum]
  • Gamma cells of pancreatic ileus

Effects

  • Stomach - Decreased Gastrin
  • Intestine - < fluid absorption, > secretion
  • Pancreas - Decrease endo and exocrine secretions
  • Liver - Decrease bile flow

29

Week 237

 

Where is vasoactive intestinal peptide produced? Which organ(s) does it affect, and how?

Produced:

  • ENS Neurons (Enteric nervoous system)

Effects:

  • Small intenstine and pancreas: Increased secretions
  • Small intestine: Relaxes smooth muscle

30

Week 237

 

Which 4 things do you need to digest and absorb fats?

  • Bile salts
  • Pancreatic lipase
  • Ileum (absorption)
  • Terminal ileum: bile salt absorption

 

31

Week 237

 

What are the symptoms of Vitamin A deficiency?

  • Night blindness
  • Xeropthalmia
  • Benign Intracranial hypertension

 

32

Week 237

 

What are the symptoms of Vitamin Deficiency?

  • Rickets/Osteomalacia

33

Week 237

 

What are the symptoms of Vitamin E Deficiency?

  • CVD
  • Haemolysis
  • Peripheral neuropathy/ataxia/opthalmoplegia

34

Week 237

 

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.

35

Week 237

 

Vitamin K affects which clotting factors?

2, 7 , 9 , 10

36

week 237

 

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
stools daily.
 

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
malabsorption.

 

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,
dysmotility etc)

37

Week 237

 

With a patient that has an entire ileo-jejunal resection (including ileo-caecal valve) - what medications would be regularly required?

  • B12
  • Fat soluble vitamins ADEK
  • Try loperamide (cautiously)

 

38

Week 237

 

Microcytic, hypochromic anaemia is associated with deficiency of what?

Iron

39

Week 237

 

Low serum ferritin is a sign of absence of what?

Iron

40

Week 237

 

Transaminitis is associated with what?

Associated with coeliac disease

 

41

Week 237

 

Raised Alk. Phos. may be normal in growing children - may aso indicate which pathology?

Osteomalacia (Vitamin D malabsorption)

 

 

42

Week 237

What is selective IgA deficiency associated with?

Coeliac disease and other autoimmune conditions

43

Week 237

 

Other than Villous hyperplasia, what histologically features of Coeliac disease are there?

  • Crypt hyperplasia
  • Dense inflammatory cell infiltrate in the lamina propria

44