LEARNER OBJECTIVES
At the completion of this chapter, the learner will be able to:
Section 1: Gross Anatomy of the Small Intestine
1.1 Describe the anatomy of the duodenum, jejunum, and ileum.
Section 2: Small Intestinal Motility
2.1 Describe the primary function of the small intestine.
Section 3: Principles of Absorption
3.1 Discuss the principles of absorption as related to the small intestine.
Section 4: Absorption of Vitamins and Minerals
4.0 Describe the normal pathway of absorption for:
4.1 pteroylglutamates
4.2 Vitamin B12
4.3 Iron
4.5 Discuss the normal assimilation of fat-soluble vitamins (A, D, E, and K).
Section 5: Absorption of Water and Electrolytes
5.1 Explain the small intestine's passive permeability to ions and water.
5.2 Describe active electrolyte absorption along the intestine.
5.3 Describe active electrolyte secretion along the intestine.
Section 6: Absorption of Fat
6.1 Discuss the process of fat digestion and absorption.
Section 7: Absorption of Carbohydrates
7.1 Name the main carbohydrates in the human diet.
7.2 Discuss the process of carbohydrate digestion and absorption.
Section 8: Absorption of Protein
8.1 Describe the process of protein digestion and absorption, including
intraluminal digestion and cellular digestion.
Section 9: Maldigestion and Malabsorption: The Malassimilation Syndromes
9.1 List the diseases that can cause malassimilation.
9.2 Describe the clinical signs and symptoms of malassimilation.
9.3 Discuss the manifestations of carbohydrate, fat, and protein
malassimilation.
9.4 Describe the manifestations of iron deficiency.
9.5 Describe the manifestations of calcium, vitamin D, and magnesium
malabsorption.
9.6 Explain the process of determining if maldigestion and/or malabsorption
exist.
9.7 Describe intraluminal maldigestion and intramural malabsorption.
9.9 Discuss the specific treatments for maldigestion and malabsorption.
Section 10: Acute Diarrhea
10.1 Define acute diarrhea and discuss its causes.
10.2 Differentiate between bacterial diarrheas and viral gastroenteritis.
10.3 Discuss parasitic enteritis.
10.4 Discuss drug-related diarrhea.
Section 11: Chronic Diarrhea
11.1 Discuss the pathogenic mechanisms of chronic diarrhea.
11.2 Discuss diagnostic plans in patients with chronic diarrhea.
Section 12: Disaccharidase Deficiencies
12.1 Define disaccharide intolerance.
Section 13: Gluten-Induced Enteropathy (Celiac Disease)
13.1 Describe celiac disease, including clinical features, laboratory
findings, treatment, and complications.
Section 14: Short Bowel Syndrome
14.1 Discuss the short bowel syndrome, including severity of symptoms,
types of diarrhea that can develop after ileal resection, and metabolic
complications.
Section 15: Postgastrectomy Malabsorption
15.1 Explain postgastrectomy malabsorption.
Section 16: Normal Small Intestinal Flora
16.1 Describe normal small intestinal flora.
16.2 Discuss the mechanisms controlling normal small intestinal flora.
Section 17: Bacterial Overgrowth Syndrome
17.1 Describe the clinical presentations of the bacterial overgrowth
syndrome.
17.2 Discuss the underlying conditions associated with bacterial
overgrowth.
17.3 Outline the management of the bacterial overgrowth syndrome,
including diagnosis and treatment.
Section 18: Protein-Losing Enteropathy
18.1 Describe protein-losing enteropathy, including causes and
management.
Section 19: Meckel's Diverticulum
19.1 Define Meckel's diverticulum.
19.2 Discuss complications of Meckel's diverticulum.
Section 20: Carcinoid Syndrome
20.1 Describe the principal manifestation of the carcinoid syndrome.
20.2 List the biochemical tests used in diagnosing the carcinoid syndrome.
20.3 Discuss pharmacologic agents used in treating the carcinoid
syndrome.
Section 21: Whipple's Disease
21.1 Describe Whipple's disease including typical features and treatment.
Section 22: Idiopathic Intestinal Pseudo-obstruction
22.1 Define idiopathic intestinal pseudo-obstruction.
22.2 Discuss treatment of idiopathic intestinal pseudo-obstruction.
Section 23: Small Intestinal Vascular Disorders
23.1 Differentiate between acute and chronic mesenteric ischemia,
including causes, patient characteristics, and treatment.
Section 24: Small Bowel Tumors
24.1 Describe benign small bowel tumors, including primary and secondary
tumors.
24.2 Describe malignant neoplasms of the small intestine.
LEARNER WORKBOOK
EXERCISE 1
1.0 Describe the anatomy of:
1.1 Duodenum
Answer (section 1.1, p183-184)
1.2 Jejunum and ileum
Answer (section 1.2, p184)
EXERCISE 2
2.0 Explain the primary function of the small intestine.
Answer (section 2, p184-185)
EXERCISE 3
3.1 Describe the normal pathway of absorption for:
3.2 Explain the small intestine's passive permeability to ions and water.
Answer (section 5.1, p191)
3.3 Differentiate between active electrolyte absorption and secretion along
the intestine.
Answer (section 5.2 & 5.3, p191-197)
3.4 Describe the normal digestion and absorption processes of:
EXERCISE 4
4.1 List five causes of defective intraluminal digestion and five causes of
defective intramural absorption.
| Intraluminal Digestion | Intramural Absorption |
| 1. |
| 2. |
| 3. |
| 4. |
| 5. |
Answer (Section 9.1, table 3, p207)
4.2 Explain the manifestations of:
4.3 Explain the process of determining if maldigestion and/or malabsorption
exist.
Answer (section 9.7, p213-214 & figure 14)
4.4 Intraluminal maldigestion occurs as a result of (1)
____________________, (2) __________________, and (3)
____________________.
Answer (section 9.8, p215)
4.5 Intramural malabsorption occurs as a result of (1)
____________________, (2) __________________, or (3)
______________________.
Answer (section 9.9, p218)
4.6 List the specific treatments for malassimilation syndromes.
| Site of Defect | Therapy |
| 1. |
| 2. |
| 3. |
| 4. |
Answer (section 9.10, table 6, p219)
EXERCISE 5
5.1 What are the causes of acute diarrhea?
Answer (section 10, table 8, p223)
5.2 What are the differences between bacterial diarrheas and viral
gastroenteritis?
Answer (section 10.1 & 10.2, p223-229)
5.3 What are the characteristics of traveler's diarrhea?
Answer (section 10.1.3, p228-229)
5.4 What are the four basic mechanisms that cause chronic diarrhea?
Explain each, including causes.
Answer (section 11.1, table 11, p234; table 12, p235; table 13, p238)
5.5 Define disaccharide intolerance.
Answer (section 12, p240-241)
5.6 Describe celiac disease, including clinical features, laboratory findings,
treatment, and complications.
Answer (section 13, p242-248)
EXERCISE 6
6.1 The severity of symptoms following resections of large segments of the
small bowel is related (1) to the extent of the resection, (2) to the specific
level of the resected bowel, and (3) to the reason for which the resection
was undertaken.
Explain the importance of the three points identified in the above
statement.
Answer (section 14, p248)
6.2 Two major types of diarrhea can develop after massive ileal resection.
Identify the two types and the reasons for development.
Answer (section 14, p248 last paragraph-p249)
EXERCISE 7
7.1 What are the mechanisms controlling normal small intestinal flora?
Answer (section 16, p250-251)
7.2 What are the clinical presentations of the bacterial overgrowth syndrome?
Answer (section 17, p251-252 & table 17)
7.3 What are the underlying conditions associated with bacterial overgrowth?
Answer (section 17, p251, table 16)
7.4 Outline the management of the bacterial overgrowth syndrome.
Answer (section 17, p253)
EXERCISE 8
8.1 Explain protein-losing enteropathy, including causes and treatment.
Answer (section 18, p254-255)
8.2 Define Meckel's diverticulum and describe its complications.
Answer (section 19, p255)
8.3 What are the presenting symptoms of the carcinoid syndrome?
Answer (section 20, p255)
8.4 What biochemical tests are used in diagnosing the carcinoid syndrome?
Answer (section 20, p256)
8.5 Explain Whipple's disease, including typical features and treatment.
Answer (section 21, p256)
8.6 What is idiopathic intestinal pseudo-obstruction?
Answer (section 22, p256-257)
EXERCISE 9
9.1 Explain the differences between acute and chronic mesenteric
ischemia, including causes, patient characteristics, and treatment.
Answer (section 23, p257-259)
EXERCISE 10
10.1 What are the three most frequently discovered benign primary tumors
of the small intestine?
Answer (section 24.1, p259, paragraph 1)
10.2 What are the presenting features of a symptomatic benign tumor?
Answer (section 24.1, p259, paragraph 2)
10.3 What are the four most common primary small bowel malignant tumors?
Answer (section 24.2, p260)
