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Week 11: Weight Loss/Malabsorption > Assessment of Malabsorption and Celiac > Flashcards

Assessment of Malabsorption and Celiac Flashcards

1
Q

Malabsorption vs maldigestion

A

Maldigestion: defective hydrolysis of nutrients
Malabsorption: defective mucosal absorption

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2
Q

4 types of problems from a luminal defect

A

Solubilization
Digestion
Liberation
Chemical changes

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3
Q

Iron can only be absorbed in what form?

A

Fe2+

Citrus can convert from 3+ to 2+

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4
Q

What is absorbed in the proximal small intestine?

8

A 
Fat
Sugars
Peptides and amino acids
Iron*
Folate
Calcium
Water
Electrolytes
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5
Q

What is absorbed in the middle small intestine? (5)

A 
Sugars
Peptides and amino acids
Ca
Water
Electrolytes
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6
Q

What is absorbed in the distal small intestine? (4)

A

Bile salts
Vitamin B12
Water
Electrolytes

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7
Q

What is absorbed in the colon? (4)

A

Water
Electrolytes
Medium chain triglycerides
Amino acids

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8
Q

How can the mucosal adapt to changes?

A

Increases in the number of villus enterocytes and in villus height
Absorptive capacity may be enhanced up to 5-fold

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9
Q

3 major ways to clinically assess malabsorption

A

Anthropometry
Biochemical
Screening tools

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10
Q

Anthropometry assessments for malnutrition

A 
BMI
Height, weight
Hip to waist ratio
Skinfold (subcutaneous fat)
Muscle bulk
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11
Q

2 screening tools for malnutrition

A

Subjective global assessment (includes physical exam - sc fat, edema, muscle bulk)
Mini-nutritional assessment (includes BMI or sc fat)

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12
Q

Mild/moderate malnutrition

A 
Moderate weight loss (5-10%)
Compromise in food intake
Continued weight loss
Progressive functional impairment
Moderate stress
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13
Q

Severe malnutrition

A

Severe weight loss (> 10%)
Poor nutrient intake
Progressive functional impairment
Muscle wasting

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14
Q

Hydrogen breath test

A

Want to see if they can digest lactose
Measure baseline, ingest lactose, then blow into bag every 30 mins and see how much gas they produce
If you cannot digest lactose you turn it into gas

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15
Q

Quantitative fecal fat

A

Collect stool for 24 hours

Can detect pancreatic insufficiency

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16
Q

Why would you measure fecal elastase?

A

Faster way of assessing pancreatic insufficiency

Higher sensitivity but low specificity

17
Q

How is vitamin B12 absorbed?

A 
Ingested bound to food
Salivary R protein liberates it
Trypsin digests R protein
B12 binds to intrinsic factor
Absorbed with IF in ileum
Trancobalamin 2 transports B12 to liver
18
Q

Schilling Test

Step 1

A

Confirm B12 malabsorption
Give large dose IM non-labelled B12 to saturate the carriers
Give small dose oral radiolabelled B12 that is absorbed by the intestine
Measure radiolabelled B12 in urine
Malabsorption if < 7-10% of oral dose recovered

19
Q

Schilling Test

Step 2

A

Confirm sites of B12 absorption
Give oral intrinsic factor (if it helps, they have pernicious anemia)
Give pancreatic enzyme (if it helps, they have pancreatic insufficiency)
Give antibiotics (if it helps, they have a small intestinal bacterial overgrowth that is eating all their B12)

20
Q

What is the genetic susceptibility for celiac disease?

A

HLA-DQ2 or HLA-DQ8

21
Q

Classic vs atypical celiac disease

A

Classic: gluten-sensitive enteropathy and malabsorption
Atypical: gluten-sensitive enteropathy and extraintestinal symptoms and signs (short stature, anemia, osteoporosis, and infertility)

22
Q

Silent vs latent vs potential celiac disease

A

Silent: gluten-sensitive enteropathy found after a serologic screening in asymptomatic patients
Latent: normal villus architecture on a gluten-containing diet but have had/will have gluten-sensitive villus atrophy
Potential: never had a biopsy consistent with celiac disease but show immunologic abnormalities characteristic for the disease. Patients often have a genetic predisposition

23
Q

Refractory celiac disease

A

Symptomatic

Severe small intestinal villus atrophy but does not respond to at least 6 months of a strict gluten-free diet

24
Q

4 histological findings in classic celiac disease

A

Villus atrophy
Crypt hyperplasia
Enterocyte disarray
Inflammatory infiltrates

25
Q

Where in the small intestine does celiac affect?

A

Proximal > distal

26
Q

Malabsorption in celiac

A

Decreased absorption ability (increased stool volume and osmotic load)
Secretion of electrolytes into lumen
Decreased release of bile acid and pancreatic enzymes in response to meals
Unabsorbed bile salts

27
Q

3 things to look for on serology for celiac

A

Anti-tTG IgA
Anti-Endomysial antibody
Anti-gliadin antibodies (IgA, IgG)

28
Q

Treatment for celiac

A

Gluten free diet
Dietary supplementation (for vitamins)
Monitor associated diseases

Week 11: Weight Loss/Malabsorption (8 decks)

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