DISEASES

IN SMALL
INTESTINE
GROUP IV - IIIBSND
THE SMALL INTESTINE
A long tube-like organ that
connects the stomach and the large
intestine.

- 20 feet long
- Has three parts: the duodenum,
jejunum, and ileum
STRUCTURE OF THE SMALL INTESTINE

The structure of the small

intestine is designed for absorption of
nutrients. The inside of the small
intestine is lined with villi that absorb
nutrients from the liquid mixture called
chyme produced in the stomach from the
food we eat.
 01

Celiac Disease
By: Angelica Mae Danao
CELIAC DISEASE DEFINITION:

- serious autoimmune
disease that causes
damage to the small
intestine (mainly happens
in the duodenum)
PATHOPHYSIOLO
GY OF CELIAC
DISEASE
• Lumen – where the food passes
through or flows.

• Enterocytes – cells of intestinal

lining.

• Lamina Propria – basement

membrane; contains other cells.

• Mucus – lines and protects the

mucosal cells.
• Crypt – sits in an invagination
(pouch) of the intestinal wall.

• Villi (Villus for singular) – small

finger-like projections that
extends into the lumen of the
small intestine; designed for
absorption of nutrients.

• Microvilli – absorbs nutrients and

protects the body from intestinal
bacteria.
• IgA (Immunoglobulin A)
dimeric antibodies
- IgA is the most abundant antibody
in mucosal secretions.
- Controls and neutralizes bacteria.

• Antigen-presenting cells (APCs)

- an immune cell that detects,
engulfs, and informs the adaptive
immune response about an infection.
• Peyer’s patches - groupings of
lymphoid follicles in the mucus
membrane (lamina propria) that
lines your small intestine.

• MLN (Mesenteric Lymph

nodes) - Another important lymphoid
tissue where the activation of T-cells
takes place.

• Naïve T-cells (Inactivated T-

cells)
• Gliadin goes through the enzyme
Tissue Transglutaminase, and gets
converted into Deamidated Gliadin
Peptide and gets picked up by the
APCs (Antigen-presenting cells).
• Then the Activated T-cell will turn
into EITHER the CD8 T-killer cell
(Cytotoxic T-lymphocyte) or the
CD4 T-helper cell (the helper cells).
• The CD8 T-killer cell will kill things.

• The CD4 T-helper cell helps other

cells.

• And their work will cause

inflammation.
The inflammation will cause
damages to the lining of the small
intestine:

• Villous Atrophy

• Hyperplasia of Intestinal
Crypts

• Increase of Lymphocytes in the

Lamina Propria

• Cell Death
SIGNS AND SYMPTOPMS

- Diarrhea
- Fatigue
- Weight loss
- Bloating and gas
- Abdominal pain
- Nausea and vomiting
- Constipation
SIGNS AND SYMPTOPMS

- Nutritional deficiency
O Anemia –iron deficiency
o Folate deficiency
- Vitamin D deficiency
O Rickets
O Hypocalcemia
- Vitamin K deficiency
O Coagulopathy
- Growth
- Short stature
- Delayed puberty
 DIETARY MANAGEMENT
Gluten-free diet
avoiding all foods that
contain wheat (including spelt,
triticale, and kamut), rye, and
barley. Despite these restrictions,
people with celiac disease can eat
a well-balanced diet with a variety
of foods, including gluten-free
bread and pasta. For example,
instead of wheat flour, people can
use potato, rice, soy, or bean flour.
Gluten-free diet not
working?
If your symptoms continue or
come back after you start a
gluten-free diet, it may be caused
by consuming small amounts of
gluten, other health problems, or
refractory celiac disease.
Keep a food journal and talk
with your doctor and a registered
dietitian.
 MEDICAL MANAGEMENT
Serology testing
Serology testing looks for
antibodies in your blood.
Elevated levels of certain
antibody proteins indicate an
immune reaction to gluten.
Genetic testing
for human leukocyte antigens
(HLA-DQ2 and HLA-DQ8)
can be used to rule out celiac
disease.
 MEDICAL MANAGEMENT
If the results of the tests indicate celiac disease, your doctor will likely order one of
the following tests:.

Endoscopy Capsule endoscopy

This test uses a long tube with
a tiny camera that's put into
your mouth and passed down
your throat (upper endoscopy).
The camera enables your
doctor to view your small
intestine and take a small
tissue sample (biopsy) to
analyze for damage to the
villi..
This test uses a tiny wireless
camera to take pictures of your
entire small intestine. The
camera sits inside a vitamin-
sized capsule, which you
swallow. As the capsule travels
through your digestive tract,
the camera takes thousands of
pictures that are transmitted to
a recorder.
 02

Diarrhea
By: Aiza R. De Guzman
Diarrhea refers to the passage of
stools of liquid to semi - liquid
consistency at frequent intervals
along the digestive tract.
TRIVIA
The most common categories of diarrhea:

ACUTE - less than 2 weeks duration

- caused by viral, bacteria or protozoan infections; by intention
or side effect of medication or by altered dietary intake.

CHRONIC - longer than 2 weeks duration

- cause for concern.
-can result from other disorders like malabsorption or
protein energy malnutrition, or medical treatments.
PATHOPHYSIOLOGY
OF DIARRHEA • fluids are not
absorbed as the
intestinal contents
move quickly
through the GI tract
and this is added to
the food residue.
 DIETARY MANAGEMENT

Potassium
Dietary Management
Fiber
Placed on NPO for 12 hrs
with IVF and electrolytes. Vitamin and Iron
Supplementation
Liberal Fluid Intake
Oral Rehydration
Electrolytes
MEDICAL MANAGEMENT

• Pedialyte
• Resol

• Loperamide
••
BIsmuth
subsalicylate
 03

Constipation
By: Aiza R. De Guzman
 Constipation means having
infrequent and difficult
(sometimes painful) passage of
small amounts of hard, dry stools.”
CAUSES OF CONSTIPATION

- Poor diet
- Lack of exercise
- Immobility/ Prolonged bed rest
- Use of certain medications
- Poor bowel habits
- Laxative abuse
- Specific disease
- Loss of body salts
 3 TYPES OF CONSTIPATION
ATONIC CONSTIPATION
is sometimes called the "lazy bowel" constipation
because of less of rectal sensibility; the rectum is full of feces but
01 the urge to defecate is lacking.
 3 TYPES OF CONSTIPATION

SPATIC CONSTIPATION
caused by an overstimulation of the intestinal nerve
02 endings which results in irregular contractions of the bowel.
 DIETARY MANAGEMENT

56%

27g
8%

atonic and spastic require a In obstructive, low residue

consisting 20-30 g/day of
high fiber diet and liberal diet
dietary fiber
fluid intake
 3 TYPES OF CONSTIPATION

OBSTRUCTIVE CONSTIPATION AND

03 CANCER OF THE BOWEL
obstruction or closure hinders the passage of intestinal
residue. The obstruction may be complete or partial. Adhesions,
cancer, a tumor or an impaction usually causes the obstruction.
A low residue diet is given in the amount related to the size of the
obstruction. If the obstruction is very extensive, a liquid diet may
be necessary.

Dietary Management for Post – Operative

Should be fiber-free for a period, after which, a soft diet is usually

ordered.
 04
Diverticular
Disease
By: Jamylle Del Rosario
DIVERTICULAR DISEASE
A disease characterized by the formation of Diverticula.
DIVERTICULAR DISEASE
There are 2 types of Diverticula:

TRUE FALSE
DIVERTICULUM DIVERTICULUM
 MECKEL’S
DIVERTICULUM
- Meckel's diverticulum was first
explained by Fabricius Hildanus
in the sixteenth century and later
named after Johann Friedrich
Meckel, who described the
embryological origin of this type
of diverticulum in 1809.

- Common congenital anomaly of

the G.I. tract. Mainly located in
the small intestine.

- Out-pouching in the ileum

- True Diverticulum

- The out-pouching is the vestigial

remnant of vitelline duct.
PATHOPHYSIOLOG
Y OF MECKEL’S
DIVERTICULUM
EMBRYONIC FOLDING

- On the 4th week of human development, the embryo

will fold from a flat plate into a 3D curve. With the
skin outside, and gut on the inside.

- Ectoderm - the outer layer; source of various tissues

and structures of the embryo.

- Mesoderm – the middle layer; gives rise to the

muscle cells and connective tissues.

- Endoderm – inner most layer; development of the

G.I. tract.

- Yolk sac – provides embryo with nourishment.

- The embryo continues to fold on the 4th week. We
can now see the Endoderm moves along the mid
line, incorporating the dorsal part of the yolk sac to
create the Primitive gut tube.

- Primitive gut tube – divided into 3 parts: Foregut,

Midgut, & Hindgut.

- The Midgut remains connected into the yolk sac until

the fifth week 5th week of development.

- On the 5th week, as the Ectoderm curves further, the

connection of the yolk sac narrows, and now called
the Vitelline Duct which is the one that will cause
Meckel’s Diverticulum.
- As the embryo progress, the 3 germ layers continues
to develop to their specific organ systems.

- Vitelline Duct (Omphalomesenteric Duct):

- connection of the yolk sac to the primitive gut.
- present during the embryonic development but it is
supposed to go away.
- failure regression that typically occurs at 5-7 weeks in
the utero.
- Can cause Volvulus (twisting of intestine).
THE RULE OF 2s
- 2% of the population

- 2-3:1 male-to-female ratio (males are more

symptomatic).

- 2-4% symptomatic

- Found within 2 feet of the ileocecal valve (door

between the small and large intestine)

- 2 inches long

- 2 inches in diameter

- 2 years old is the most common presentation

SIGNS AND SYMPTOMS:
- Often times, a patient is asymptomatic in adulthood. But in cases where the patient is
symptomatic, the risk factors are: Young Age; Male; having chronic diverticulum.

- Gastrointestinal Bleeding (can be seen in stools).

- Abdominal pain and cramping

- Tenderness near the navel (belly button)

- Bowel obstruction – blockage that keeps the contents of the intestine from passing. Can
cause bloating, diarrhea, constipation, and vomiting.

- Diverticulitis – inflammation or infection of the diverticulum.

- Anemia
SIGNS AND SYMPTOMS:

Intussusception Perforation
SIGNS AND SYMPTOMS:

Omphalomesenteric fistula Umbilical Cyst

DIAGNOSIS:
If asymptomatic, M.D. can be difficult to detect, often times it can be an incidental
finding:

- Laparoscopy (keyhole surgery) - AXR (Abdominal X-ray)

DIAGNOSIS:
If symptomatic, it can be detected with:

- Technetium-99 pertechnetate scanner - Angiography

DIAGNOSIS:
If symptomatic, it can be detected with:

- CT (Computerized tomography) scan

TREATMENT

Surgical Resection – if it has hemorrhage, diverticulitis, obstruction, &

fistulas

Types of Surgery:

- Diverticulectomy - remove an abnormal pouch of the lining of the

small intestine (bowel).

- Small intestine resection with end-to-end Anastomosis (means a

connection that is created between tubular structures).
MEDICAL MANAGEMENT
- May require blood transfusion because of blood loss
- Iron supplements

DIETARY MANAGEMENT
- May prescribe to eat food rich in iron (red meat, liver, eggs, dark green leafy
vegetables).
DIVERTICULAR
DISEASE
- Disease characterized by the
formation of Diverticula in the
colon.

- Diverticula are small bulges or

pockets that can develop in the
lining of the intestine as you get
older.

- False Diverticulum
PATHOPHYSIOLOG
Y OF
DIVERTICULAR
DISEASE
 The branch of mesenteric artery that is penetrating the
colon wall is the “weak spot” of the colon.

 When pressure builds up in the Lumen due to various reasons:

- backup of fecal matter
- Swallowing excess air
- Eating high fat foods that delay stomach emptying
- Food allergies and intolerances
- Stress

 The Mucosa and Submucosa bubbles out through the weak

spot, thus, creating a Diverticula.
 COMPLICATIONS
 Bacteria and undigested food could get stuck in these protrusions
and may cause infection that will lead to:

- Bowel Obstruction

- Abscess
 COMPLICATIONS
 Bacteria and undigested food could get stuck in these protrusions
and may cause infection that will lead to:

- Fistulae

- Perforation
 COMPLICATIONS
 Bacteria and undigested food could get stuck in these protrusions
and may cause infection that will lead to:

- Hemorrhage
 SIGNS AND SYMPTOMS

 Most patients with Diverticular disease have no symptoms or

complications (Asymptomatic). However there are painful
Diverticula Disease and can become the source of serious
illness.

 Pain in the lower iliac fossa, on the left.

 Often coexist with IBD (Irritable Bowel Disease).

 Blood in stool.
 SIGNS AND SYMPTOMS

 If Diverticulitis occur, there could be:

• Nausea
• Fever
• Tachycardia
• Acute left iliac fossa pain
• Loose stool
 CAUSES AND RISK FACTORS
 Diverticular Disease is a Multifactorial Disease ( genetic
predisposition and environmental risk factors).

1. Over 40 years old - Smoking

2. A diet in low fiber and - Sedentary Lifestyle

high in fatty foods
- Alcohol use
3. Obesity
INVESTIGATION / DIAGNOSIS

• Barium Enema (Colon X-ray)

• Colonoscopy

• Laboratory Tests

• CT scans (Computerized
Tomography)
 MANAGEMENT

 MEDICAL
• There may be need of IV antibiotic, analgesia, Fluids
in hospital

 DIETARY

• Primary way treat/ prevent this disease

• Medium to high fiber diet.
• 30g fiber a day (Adult)
 MANAGEMENT

 SURGICAL

• Resection (Segmental Colectomy)

 5

Fat Malabsorption
Syndrome
By: Dianne Oxino
Malabsorption is defined as the inadequate
assimilation of dietary nutrients due to defects in
digestion, absorption, or transport.
 Fat malabsorption refers specifically to the inadequate
breakdown and uptake of fat into the body. Gluten induced
liver and intestinal damage can contribute to fat
malabsorption.
The digestion and absorption of food materials can be divided into three major
phases: luminal, mucosal, and postabsorptive.

The luminal phase is the stage in which dietary fats, proteins, and
carbohydrates are hydrolyzed and solubilized by secreted
digestive enzymes and bile.

The mucosal phase relies on the integrity of the brush-border

membrane of intestinal epithelial cells to transport digested products from the
lumen into the cells.
 In the postabsorptive phase, reassembled lipids and other key
nutrients are transported via the lymphatics and portal circulation from
epithelial cells to other parts of the body.

When disease processes perturb any of these phases, malabsorption

frequently results.
• Signs and symptoms
Examples of some immediate malabsorption symptoms that may
occur:
- bloating and stomach distention
- diarrhea
- fatigue
- gas
- steatorrhea, or stool that is pale to white
- stools that appear “greasy” in texture
- stomach cramping
- weakness
Long term effects of malabsorption.

These include:

- Weight loss or an inability to gain

weight
- Intestinal obstructions
- Diabetes
- Respiratory issues
- Chronic infections
- Impaired bone health (vitamin K
deficiency)
- Even death
 Dietary Management

- Reduce Fat
- MCT - to ensure sufficient energy intake,
medium-chain triglycerides -- MCTs -- are
sometimes used in patients with fat
malabsorption.
- Supplementation of Fat-Soluble Vitamins
- Supplementation of Minerals
 Dietary Management

FAT-RESTRICTED DIET
- Relief of abdominal symptoms (diarrhea
&flatulence)
- Minimize loss of vitamns & mnerals
- Fats should not be restricted more than
necessary
- Alternative source of dietary fat: medium-
chaintriglycerides (MCT)
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 A. Large Intestine

1. Meckel’s Diverticulum is B. Sigmoid Colon

located in the _________

C. Small Intestine
 A. Intestinal Linings
2. ________ refers to the
passage of stools of liquid to
semi - liquid consistency at B. Diarrhea

frequent intervals along the

digestive tract. C. Diverticulitis
 A. Crypts
3. small finger-like
projections that extends into
the lumen of the small B. Villi

intestine; designed for

absorption of nutrients. C. Enterocytes
 A. Malabsorption
4. ________ is defined as the
inadequate assimilation of
dietary nutrients due to B. Hyperabsorption

defects in digestion,
absorption, or transport. C. Lowkey absorption
 A. Duodenum, rectum,
uterus

5. The small intestine has B. Villi, Crypt,

three parts: Microvilli

C. duodenum,
jejunum, and ileum