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home - Small Bowel - Miscellaneous - Small Bowel Minutiae Written by Dr Sebastian Zeki
Knowledge


Defines the pathophysiology of fluid and nutrient malabsorption,
including causes, e.g. anatomical and functional short bowel
syndrome, high output stomas, enterocutaneous fistulae and
pancreatic insufficiency

Knows how to investigate patients with malabsorption
Describes the clinical consequences of malabsorption, including
malnutrition, fluid and electrolyte disturbance and micronutrient
deficiency and anaemia and how to manage these

Describes all other causes of anaemia, including bone marrow
disorders and haemolysis

Describes the metabolism, absorption and bioavailability of iron, B12
and folate and clinical conditions and diets associated with their
deficiency

Skills
Identifies and appropriately investigates clinical features suggestive of
malabsorption

Manages fluid, electrolyte and micronutrient disturbances associated
with short bowel syndrome or high output stomas

Uses the appropriate investigations for the different types of anaemia
Behaviours
Takes a careful clinical approach to managing patients with
malabsorption and anaemia. Explains plan of management clearly to
patients and their relatives.

Small Bowel Minutiae

Meckel's diverticulumIt is the vitelline duct remnant. It occurs in 2% of population. 2% bleed. It is 2cm long. It is 100cm from ileocaecal valve. It usually contain gastric tissue therefore H Pylori infection and ulcers. Patients can get cancer in it.Investigations include Technetium plus Cimetidine plus Pentagastrine. It is possible to get false positive with Crohn's. Enteroclysis is better than small bowel follow-through to make a diagnosis. Treatment involves resection only if complicated. DuplicationIt is mostly ileal. MalrotationIt results in volvulus and duodenal obstruction. Volvulus of small bowel I s normal secondary to adhesions/congenital bands/rotation anomaly. Treatment involves resection +/- antirighting. Intussusception This is the telescoping of one bit of bowel into another. 90% is due to identifiable intestinal/extra-intestinal mass. Investigations include barium enema which may also reduce intussusception. Duodenal Diverticula IV IIIb IIIa II I Atresia and stenosis types: t ype I (mucosal web). type II (fibrous cord). type IIIa (mesenteric gap defect). type IIIb ("apple peel"). type IV (multiple atresias). Duodenal stenosis and atresia associated with Down's and other congenital problems 40% get bacterial overgrowth Only 20% of these get acute problems 1% prevalenceUsually proximalAssociated with inestinal motility disorders Congenital from incomplete lumenal canalization Associated with bile duct stones (pigmented)Rarely cause obstruction/ perforation and bleeding 1% need definitive treatment Intraluminal diverticula Extraluminal diverticula Jejunal Diverticula (5% prevalence) Structural Anomalies Structural Anomalies and Minutiae of The Small Bowel