NBA11 Small intestine and diseases
28 important questions on NBA11 Small intestine and diseases
Disorders of carbohydrate metabolism and absorption
- Caused by defects in enzyme hydrolysis activity and the transport of sugars --> digestion & absorption
- systems often redundant, but some specific disorders are known
- Characterised by:
- diarrhea due to the osmotic load & presented by the undigested carbohydrate to the colon --> SCFA
- bloating and abdominal pain
- contributes to malabsorption of other nutrients
Which two microbiota are up in your GI-tract
What are the disorders of carbohydrate metabolism and absorption? And what is now known
- Defects of maltase-gluocoamylase
- sucrase-isomaltase deficiency
- lactose intolerance
- genetic
- adaptation of diet (restriction)
- addition of enzymes
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What are the disorders of carbohydrate metabolism and absorption? And what is now known
- Defects of maltase-gluocoamylase
- sucrase-isomaltase deficiency
- lactose intolerance
- genetic
- adaptation of diet (restriction)
- addition of enzymes
Where are the breath tests used for?
- Lactase deficiency is more common in IBS
- Bloating is frequent complaint
- Most commonly used:
- lactose
- lactulose
Congenital sucrase-isomaltase deficiency in an adult, what happens
- Female, 21 yrs, chronic diarrhoea from birth (since weaning)
- role of sucrose was not recognised by the physicians, the parents or the patient herself who, however, empirically followed a sucrose-free diet in later life
- glucose tolerance test: OK
- treatmetn: enzyme therapy
- prevalence: 1 in 5000
Congenital sucrase-isomaltase deficiency in an adult, what happens
- Female, 21 yrs, chronic diarrhoea from birth (since weaning)
- role of sucrose was not recognised by the physicians, the parents or the patient herself who, however, empirically followed a sucrose-free diet in later life
- glucose tolerance test: OK
- treatmetn: enzyme therapy
- prevalence: 1 in 5000
Which medical problems are there related to the small intestine?
- Obstruction
- ileus
- bile stones
- bleeding/ulcers
- drugs (NSAID, anticoagulants)
- H. Pylori/acid
- infections/inflammation
- radiation
- inflammation/infection
- Crohn's disease
- Coeliac disease
- SIBO/bacterial overgrowth
- virus, bacteria, parasites
- abdominal pain
- IBS
- adhesions
What are the symptoms and sings for medical problems related to the small intestine?
- Melaena
- Bloating
- Pain
- Diarrhea
- Malabsorption/weight loss
- Steatorrhea
- Janudice
Which intestinal obstructions are there?
- Herniation
- adhesions
- intussusceptions
- volvulus
What are the disorders of CHO metabolism and absorption
- Glucose-galactose malabsorption (SGLT1) !
- Fructose malabsorption (GLUT5?) ±
- Fanconi-Bickel syndrome (GLU
T2) !
genetic
adaptation of diet (restriction)
Congenital enteropeptidase deficiency =
- Very rare!
- redundancy
- failure to thrive, diarrhoea, hypoproteinemia, edema
genetic
Functional bowel disorders (FBD) what are the diagnostic criteria dor IBS?
- recurrent abdominal pain or discomfort
- >3 days per month in the last three months
- associated with two or more of the following
- improvement with defecation; and/or
- onset associated with a change in frequency of stool; and/or
- onset associated with a change in form (appearance) of stool
Functional bowel disorders (FBD) what is SIBO?
- definition of SIBO
- disruption of the normal small bowel bacterial population; may result in gas, bloating, flatulence, altered bowel function, or malabsorption
- widely accepted definition is >10^5 CFU/ml from the proximal jejunum
- lower cut off may be appropriate for colonic type bacteria
- wide array of effects
- direct injury, changes in function/sensation, gut immunology, permeability, and loss of brush border enzymes
- clinical manifestations from asymptomatic to bloating to frank malabsorption
What are the disorders of fat absorption?
- Abetalipoproteinemia
- ApoB48, no chylomicrons
- Chylomicron retention disease
- SAR1, rare!
- Bile acid malabsorption
- ??, rare
Genetic
lipid-soluble vitamin deficiencies --> symptoms
What is IBS and what are the common symptoms
symptoms
- painful cramps
- bloating
- diarrhoea
- constipation
- mucus in stool
- women are 2-3 times more likely to suffer from irritable bowel syndrome than men
treatment
- laxatives
- antispasmodics
- exercise
- stress release
- prune juice
What is the treatment of FBD
- Diet:
- gluten free
- FODMAP low
- Fiber (drink >2 liter)
- mediation
- hypnotherapy
- psychoterapy
- pelvic floor muscle exercise
What are the risks of deficiencies for celiac patients?
But .. Gluten-free diet may result in deficiencies in multiple nutrients
- iron, folate, zink, niacin
- vitamin B6 and B12
- Calcium, phosphate
higher in fat, lower in carbs and fibers
How does endobarrier gastrointestinal bypass liner works?
- The endobarrier is en impermeable, fluoropolymer plastic liner. It is fed through mouth and stomach into the small intestine while patient is under general anaesthetic
- once there, it unfurls, creating a two foot tube, three inches in diameter. The liner stops food from being absorbed until further down the digestive tract
- it triggers changes to hormones, bile and bacteria, which rapidly improve diabetes symptoms
- it also alters appetite hormones tricking the body into feeling full
The pathogenesis af celiac disease
- Immune system, especially T-cell intolerance to gluten peptides
- Hereditary factors: strongly HLA-associated
- HLA-DQ2 and HLA-DQ8 positive
- Environmental factors (viral infections)
IMAGE!!!
What is mucosal resurfacing?
Therapy of gluten-free diet has a very good effect on:
- Gastrointestinal complaints
- deficiencies of iron, vitamins and calcium
- osteoporosis
- skin manifestations (dermatitis herpetiformis)
- infertility and spontaneous abortion
How can low FODMAP-diets be used?
- Elimination-diet (6 weeks)
- (oligosaccharides, lactose, fructose and polyols)
- measuring effect with VAS scores
- Structured reintroduction (in case of sufficient effect)
- of each of the 4 FODMAP groups
- measuring effect with VAS scores
- Final diet without one or two FODMAPs
What is the treatment of Crohn's disease
- Corticosteroids, biologicals (anti-TNF)
- Tube feeding
- Surgery
- 'anti-inflammatory' diet
What is the definition of short bowel syndrome?
for baby's: 40 cm of intact small bowel
for adults: 60-80 cm intact small bowel
What is the etiology of the short bowel syndrome
- Adults
- mesenterial trombosis
- bowel resection after volvulus
- Crohn's disease
- Children
- congenitaal abnormalities (atresia)
- necrosing interocolites
- intestinal volvulus
What are the symptoms of short bowel syndrome?
- Diarrhoea
- Dehydration
- elektrolyte disturbances
- malnutrition (sarcopenie)
- weight loss
Fluid balance in the gut
- stomach 2-2,5
- pancreas 1
- bile 1,5
- bowel 3,5
- fermentation of CHO and soluble dietary fiber can yield 1000kcal/day SCFA
- extra absorption of water (300%)
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