Flashcards in INFECTIONS OF THE SMALL BOWEL Deck (8)
What can lead to bacterial overgrowth of the small intestine?
Bacterial overgrowth usually occurs as a result of structural abnormalities which leads to stasis (eg strictures or diverticulae) or where the caecal valve has become insufficient.
What are the bacteria normally found in the terminal ileum?
Certain faecal bacteria eg E. coli, enterococcus and Bacteroides
What are the clinical features of bacterial overgrowth of the small intestine?
Deconjugation of bile salts by bacteria leads to fat malabsorption and deficiency of fat soluble vitmamins A, D, A and K. Can also metabolise B12.
Causes steatorrhoea and deficiencies of vitamin, especially B12 (anaemia)
Diarrhoea is often presenting complaint.
What investigations should be ordered for someone with suspected bacterial overgrowth of the small intestine?
Hydrogen breath test - using oral lactulose or glucose which are metabolised by bacteria to hydrogen. Not very specific test due to oral bacteria.
14C glycocholic acid breath test - C14 bile salt ingested. Bacteria will deconjugate releasing 14CO2
Small intestine aspiration - cultures
How would you managed someone with bacterial overgrowth of the small intestine?
Prolonged cyclical courses of metronidazole, tetracycline and ciprofloxacin.
Replace vitamin deficiencies
Treat underlying cause
What is Whipple's disease?
An infection of the small intestine caused by Tropheryma whippelii (a bacteria) - may involve at type of immunodeficiency.
What are the features of Whipple's disease?
Chronic encephalitis if brain is involved