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Small Intestinal Disorders

Important Disorders of the Small Intestine. MALABSORPTIONCeliac disease, tropical sprue, Whipple's disease, bacterial overgrowthINFECTIONSGiardia, Salmonella, parasites, tuberculosisVASCULAR DISORDERS Thrombosis, ischemiaINFLAMMATORY Crohn's disease, radiationTUMORSAdenocarcinoma, lymphoma, carcinoids, benign tumors.

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Small Intestinal Disorders

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    1. Small Intestinal Disorders/Malabsorption Ralph Giannella, M.D.

    2. Important Disorders of the Small Intestine MALABSORPTION Celiac disease, tropical sprue, Whipple’s disease, bacterial overgrowth INFECTIONS Giardia, Salmonella, parasites, tuberculosis VASCULAR DISORDERS Thrombosis, ischemia INFLAMMATORY Crohn’s disease, radiation TUMORS Adenocarcinoma, lymphoma, carcinoids, benign tumors

    10. Signs and Symptoms Suggestive of Malabsorption Sign or Symptom Wasting, edema Weight loss, oily-bulky stool Parasthesias, tetany, bone pain Ecchymosis, petechiae, purpura Anemia - macrocytic - microcytic Initial Lab Finding Serum albumin Stool fat Serum carotene Serum ca, alk.phos. Mineralization of bone Prothrombin time Serum folate or vit B12 Serum iron

    11. Classification of Malabsorption PANCREATIC ENZYMES Chronic pancreatitis, Zollinger-Ellison syndrome BILE SALTS Biliary obstruction, bacterial overgrowth, ileal disease MUCOSAL DISEASE Resection, radiation enteritis, ischemia Celiac sprue, Whipple’s disease LYMPHATIC DISEASE Lymphagiectasis, lymphoma OTHER Diabetes, throtoxicosis, drugs, post-gastrectomy

    12. Screening Tests in Malabsorption Microscopic exam of feces for fat Serum carotene Prothrombin time Hemoglobin, erythrocytes, smear Plasma protein Serum calcium

    15. D-Xylose Test in Malabsorption 5-Carbon Sugar Absorbed in Small Intestine Impairment of absorption indicates Small Intestine Disease False Low Values Renal Disease Massive Ascites Bacterial Overgrowth Vomiting Delayed Gastric Emptying

    16. D-Xylose Test Helpful in Distinguishing Maldigestion from Malabsorption

    17. Small Bowel Biopsy and Malabsorption Diseases with Continuous Involvement Normal Biospy Excludes Diagnosis Celiac Disease Tropical Sprue Whipple’s Disease Agammaglobulinemia Other Diseases with Diagnostic Biopsies Intestinal Lymphoma Parasites (Giardia, Crytosporidia) Viral (CMV, Herpes) Amyloidosis Eosinophilic Gastroenteritis

    18. Disorders in Which Biopsy is Diagnostic Whipple’s Disease Agammaglobulinemia Abetalipoprotienemia

    19. Disorders in Which Biopsy May Be Diagnostic Lymphoma Lymphangiectasia MAI Crytosporidiosis Coccidiosis Giardiasis Collagenous sprue etc.

    20. Diseases Affecting the Ileum Regional Enteritis Ileal Resection Jejuno-Ileal Bypass Radiation Enteritis Carcinoid Tumors Tuberculosis Lymphoma etc.

    21. Consequences of Ileal Disease and/or Resection Vitamin B12 Malabsorption and Deficiency Steatorrhea Diarrhea Gall Stones Renal Stones Small Bowel bacterial overgrowth

    25. Renal Calculi in Ileal Disease

    28. Bacterial Overgrowth Syndrome Macrocytic Anemia (Vit B12 def) Steatorrhea Diarrhea

    29. Pathogenesis of Bacterial Overgrowth Syndromes Small Bowel Lesions

    31. Small Intestinal Bacterial Overgrowth Intestinal scleroderma Diabetic enteropathy Intestinal pseudo-obstruction SBBO of the elderly ? AIDS enteropathy

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