3.05 Malabsorption & IBD: Celiac, IBS Flashcards
“Malabsorption” denotes problems with what?
digestion or absorption
Steatorrhea implies?
fats/fat soluble findings
decreased serum cholesterol & vitamin A, carotene (fat-soluble vitamins)
xeropthalmia associated with?
vitamin A deficiency
Paresthesias, tetany, positive Trousseau (BP cuff), and Chvostek sign (cheek tap) associated with?
calcium deficinecy
Tests that differentiate digestion vs. malabsorption problems?
D-xylose test
(sugar that doesn’t need to be digested so if low = malabsorption)
OR
a-1-antitrypsin test
(if more cleared in stool than normal it means more protein loss than malabsorption)
What are the three phases of malabsorption?
- intraluminal
- mucosal
- absorptive
What gets hydrolyzed in the lumen by pancreatic/biliary secretions? Pathogenesis is focused on?**
fats** > proteins, and carbs
Mucosal phase centers on pathogenic malabsorption of?
all nutrients across the board: fat, proteins, carbs
Obstruction of what may lead to impaired chylomicron and lipoprotein absorption leading to steatorrhea/protein loss?
lymphatic system
What’s causing the bile salt issues (fat malabsorption)?
biliary obstruction, cholestatic liver diseases, or terminal ileum problem
destruction/loss of bile salts (bacteri, acid, meds)
Fat malabsorption is linked with a decency of what vitamins?
A, D, E K
What can cause pancreatic insufficiency?
chronic pancreatitis, CF, or cancer + pancreatic enzyme inactivation (ZE)
Pancreatic issues tend to result in malabsorption of what?
triglycerides
Celiac causes diffuse damage to what due to an immune response to gluten?
small intestinal mucosa
What are the demographics for celiacs?
1:100 White Euro
10% diagnosed
The “classic” GI symptoms for celiacs are most obvious in what group of people?
infants (<2yo) and become less obvious over time
Many adults with Celiacs present what kind of “atypical” manifestations with lil to no GI symptoms?
fatigue, depression, iron deficiency anemia, osteoporosis, short stature, etc.
What derm problem can appear in <10% of celiacs but is very specific?
dermatitis herpatiformis
Celiacs differentials?
IBD
lactase/pancreatic deficiency
Whipple disease
viral gastroenteritisis
eosinophilic gastroenteritis
giardiasis
gastrinoma
Intracellular gram + infection that can lead to +PAS, foamy macrophages, cardiac symptoms, arthralgias, and neuro symptoms?
T. whipplei
(“Mr. whipple likes to use soft foamy charmin on the “CAN”)
What are some generic tests you can order for Celiacs?
CBC, PT, serum: albumin, iron, ferritin, calcium, alkaline phosphatase, vitamin levels ..
What should be performed on everyone suspected of celiac?
serologic IgA endomysial or tTG tests
If IgA endomysial antibody comes back negative in patients with celiacs what should you test next?
IgA deficiency
Even if the patient has celiac, when could the serologic tests come back negative?
dietary gluten withdrawal for 3-12 months
What genes tend to lead to an increased risk of celiac and patients tend to carry?
HLA DQ2 and/or DQ8
(not diagnostic)
What can lead to a hereditary 40% risk of developing celiac disease even if asymptomatic?
same genotype as first-degree relative with celiacs
What confirms a celiac diagnosis? What can affect accuracy?
duodenal biopsy
changes in diet can affect (must still be eating gluten)
What is the treatment for celiac?
remove all gluten and maybe avoid diary until healed (a few weeks) + nutrient supplements (avoid osteoporosis)
maybe nonoral treatment/steroids
prognosis of celiacs?
excellent with tx (gluten withdraw)
if refractory (<5% then poor prognosis)
What can you find in celiac duodenal biopsy if positive?
villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis
What are people with celiac at higher risk of developing?
T cell lymphoma
What is a common, chronic disorder characterized by abdominal pain with alterations in bowel habits?
irritable bowel syndrome
What kind of disorder is IBS (no obvious abnormal physical exam findings or cause)?
functional
What is the IBS demographic?
2/3 women, usually begins late teens to early twenties
Differential for IBS?
IBD
colonic neoplasia
celiac
depression and anxiety
Diagnostic for IBS?
no definitive one
Rome II criteria
What are the Rome III criteria?
recurrent abdominal pain or discomfort for at least 3 days per month for the last 3 months with 2 or more:
relief with defecation
when in pain change in stool:
freq or form/appearance
Diagnostic testing for IBS is NOT required if??
compatible with ROME III
AND no complaint that suggest organic disease (nocturnal dx, red stool, weight loss, feecr, FHx)
When should someone with IBS get diagnostic tests?
if symptoms did not improve 2-4 weeks post empiric therapy
What are some tests you should do if a patient with IBS is diagnosed and refractory to tx after a month?
Complete CBC + serum tests, thyroid function tests, celiac tests, ova+ parasite tests, small bowel parasite overgrowth, lactose intolerance test
At what point should screen patients for colonic neoplasms with a colonoscopy?
> 50 yo
or symptoms unrefractory to empiric therapy
What are therapeutic procedures for IBS?
reassure patient
regular follow up
behavioral modification with relaxing/hypnotherapy technique, moderate exercise is helpful
IBS prognosis?
chronic, episodic, majority learn to cope
