Week 237 - Malabsorption/Chronic Diarrhoea Flashcards by Carey Girling

Week 237

What is Coeliac Disease?

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

It causes Villous Atrophy and Malabsorption

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Week 237

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

HLA-DQ2

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Week 236

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

Tissue Transglutaminase

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Week 236

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

Proximal SI (especially duodenum)

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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

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Week 236

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

Coeliac disease.

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Week 236

What are the symptoms of B12 deficiency?

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

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Week 236

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

Pernicious anaemia (Vit B12 deficiency)

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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.

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Week 236

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

Fructose.

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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

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Week 236

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

Chylomicrons

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Week 236

Which important element is absorbed in the Duodenum?

IRON

Also, Calcium, Magnesium, and Zinc.

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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

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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

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Week 237

What do the Duct cells of the Pancreas produce?

Bicarbonate/water

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Week 237

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

Acinar cells

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Week 237

The Jejenum is important for the absorbtion of which things?

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

Week 237

What is absorbed in the Proximal Ileum?

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

Week 237

What is absorbed in the Distal Ileum?

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Bile salts
Intrinsic Factor/Vitamin B12 complex

Week 237

What does the Ileo-caecal valve regulate?

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Rregulates fat and bile absorption
Prevents bacterial contamination of ileum

Week 237

What does the colon absorb?

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

Week 237

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

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Secreted from:

Duodenum
Jejenum
Ileum
Colon

Target organ(s) and action(s):

Pancreas - Increased enzyme secretions
Gallbladder - Contraction

Week 237

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

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Produced in:

G cells of Gastric Antrum

Target organ(s) and Action(s);

Parietal cells in the gastric body - H+ secretion

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**.

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.

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

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

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

Week 237 Which **4 things** do you need to digest and absorb fats?

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

Week 237 What are the **symptoms of Vitamin A deficiency**?

* Night blindness * Xeropthalmia * Benign Intracranial hypertension

Week 237 What are the **symptoms of Vitamin Deficiency**?

* Rickets/Osteomalacia

Week 237 What are the **symptoms of Vitamin E Deficiency**?

* CVD * Haemolysis * Peripheral neuropathy/ataxia/opthalmoplegia

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.**

Week 237 Vitamin **K** affects **which clotting factors**?

2, 7 , 9 , 10

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)

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)

Week 237 Microcytic, hypochromic anaemia is associated with deficiency of what?

Iron

Week 237 Low serum ferritin is a sign of absence of what?

Iron

Week 237 **Transaminitis** is associated with what?

Associated with coeliac disease

Week 237 Raised Alk. Phos. may be normal in growing children - may aso indicate which pathology?

Osteomalacia (Vitamin D malabsorption)

Week 237 What is selective IgA deficiency associated with?

Coeliac disease and other autoimmune conditions

Week 237 Other than Villous hyperplasia, what histologically features of Coeliac disease are there?

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

Week 237 - Malabsorption/Chronic Diarrhoea Flashcards

(44 cards)