Contents 1 General Learning Objectives 1.1 What are the vit. K dependant prothrombin factors? 1.2 What is the difference between malabsorption and maldigestion? 1.3 What is the D-xylose test? 2 Normal small intestine 2.1 What is the physiology of the small intestine? 2.2 Where does digestion and absorption occur in the small intestine? 2.3 What is the histologic structure of the small intestine? 2.4 Why do regions of the small intestine have different absorption abilities (different cell types?)? 2.5 What is the gross structure of the small intestine? 2.6 What is the vascular supply to the small intestine? 2.7 What is the innervation of the small intestine? 2.8 What is the role of the immune system in the small intestine? 3 Celiac Disease 3.1 What is the pathophysiology of celiac disease? 3.2 How do you diagnose celiac disease? 3.3 What are the IgA endomysial and tissue transglutaminase antibody tests? 3.4 What are the differentials? What else can cause malabsorption? 3.5 What are the treatments for celiac disease? 3.6 What are the complications of celiac disease? 3.7 What special diet must be followed? 3.8 What happens if he doesn’t change his diet? 3.9 How do you get Celiac disease?

[edit] General Learning Objectives

[edit] What are the vit. K dependant prothrombin factors?

[edit] What is the difference between malabsorption and maldigestion?

[edit] What is the D-xylose test?

[edit] Normal small intestine

[edit] What is the physiology of the small intestine?

[edit] Where does digestion and absorption occur in the small intestine?

[edit] What is the histologic structure of the small intestine?

[edit] Why do regions of the small intestine have different absorption abilities (different cell types?)?

Sites of absorption of potentially malabsorbed substances:

• Proximal duodenum: monosaccharides
• Distal duodenum: disaccharides, fat-soluble vitamins, iron, calcium
• Jejunum: proteins (as amino acids), starch (as glucose), water-soluble vitamins
• Ileum: fats
• Terminal ileum: bile salts, cobalamines

Color Atlas of Pathophysiology

MDM

[edit] What is the gross structure of the small intestine?

[edit] What is the vascular supply to the small intestine?

• Duodenum:
  • Arterial supply from two different vessels.
  • Important transition in blood supply occurs approximately where the bile duct enters. This is the site of the embryological junction of the foregut and midgut.
  • Proximal portion supplied by branches of the celiac trunk.
  • Distal portion supplied by branches of the superior mesenteric artery.
  • Duodenal veins follow the arteries and drain into the portal vein.

• Jejunum and Ileum:
  • Arterial supply from branches of superior mesenteric artery.
  • Venous drainage from the superior mesenteric vein, which ends posterior to the neck of the pancreas where it unites with the splenic vein to form the portal vein.

Moore's Essential Clinical Anatomy

MDM

[edit] What is the innervation of the small intestine?

[edit] What is the role of the immune system in the small intestine?

[edit] Celiac Disease

[edit] What is the pathophysiology of celiac disease?

Classic celiac disease (aka gluten-sensitive enteropathy) has three features: atrophy of the villi in the small intestine, malabsorption (with accompanying symptoms of weight loss, steatorrhea, and other vitamin/nutrient deficiencies), and healing of mucosal lesions and symptoms when gluten-containing foods are removed from the diet.

Source: UpToDate

ASR

[edit] How do you diagnose celiac disease?

[edit] What are the IgA endomysial and tissue transglutaminase antibody tests?

[edit] What are the differentials? What else can cause malabsorption?

[edit] What are the treatments for celiac disease?

[edit] What are the complications of celiac disease?

GI and non-GI neoplasms and intestinal lymphoma are increased in patients with celiac disease. Complications also include intestinal ulceration, refractory sprue and collagenous sprue.

Source: Access Medicine

Not exactly complications, but...celiac disease is associated with several other conditions, including dermatitis herpetiformis, Down syndrome, selective IgA deficiency, menstrual abnormalities and infertility, and other conditions which have autoimmune features such as type 1 diabetes mellitus, thyroid disease, and liver disease. Patients with celiac disease (and their families) may also be more likely to have atopic dermatitis compared with the general population, although the prevalence of other allergies is not increased.

Source: UpToDate

ASR

[edit] What special diet must be followed?

A gluten-free diet. Here's some advice from a website that sells gluten-free products:

Gluten is hidden in many unsuspecting foods such as licorice, soy sauce, malt vinegar, some flavorings, most processed foods, self-basting turkeys, some cold cuts, and many prepared stocks and soups. Vinegars and alcohols that are properly distilled should not contain any harmful gluten. However, if additives have been added after the distillation process, they may contain gluten. Gluten is also used as a binder in some pharmaceutical products and can be the starch in unidentified food starch, modified food starch, caramel coloring, hydrolyzed plant or vegetable protein. It's also important to avoid products where the ingredients are of questionable origin or are listed as simply "natural flavorings, flavor extracts, or spice extracts" as gluten may be used in processing them.

Plain rice of all types (including wild rice), tapioca, potatoes, corn, and legumes are safe for a gluten-free diet. Most celiac patients can also tolerate soy products, except soy sauce which is usually fermented with wheat.

Source: www.glutenfree.com

ASR

[edit] What happens if he doesn’t change his diet?

[edit] How do you get Celiac disease?