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GIR Test 2 > B5-072 CBCL: Malabsorption > Flashcards

B5-072 CBCL: Malabsorption Flashcards

1
Q

associated with enterotoxin traveler’s diarrhea

A

secretory diarrhea

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2
Q

not affected by prolonged fasting

A

secretory diarrhea

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3
Q

ceases during prolonged fast

A

osmotic diarrhea

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4
Q

what kind of diarrhea does lactase deficiency cause?

A

osmotic

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5
Q

primary functions of bile acids

A
  1. promote bile flow
  2. breakdown cholesterol/phospholipids in gallbladder via mixed micelles
  3. enhance dietary lipid digestion and absorption in proximal intestine via mixed micelles
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6
Q

decreased bile acid synthesis due to decreased hepatic functions

A

cirrhosis

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7
Q

decreased biliary secretion due to defective canalicular excretion of organic anions

A

primary billiary cirrhosis

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8
Q

failure of maintenance of conjugated bile acids due to bacterial overgrowth

A

jejunal diverticulosis

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9
Q

decrease in the reabsorption of bile acids due to decreased delivery to the large intestine

A

Crohn’s or surgical resection

results in fatty acid diarrhea

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10
Q

bile acid diarrhea is due to […] ileal disease

A

limited

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11
Q

fatty acid diarhhea is due to […] ileal disease

A

extensive

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12
Q

in fatty acid diarrhea, the fecal-bile acid loss is not compensated by hepatic synthesis causing in impaired micelle formation and resulting in

A

steatorrhea

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13
Q

does bile acid diarrhea respond to cholestyramine?

A

yes

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14
Q

does fatty acid diarrhea respond to cholestyramine?

A

no

can make it worse

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15
Q

does bile acid diarrhea respond to a low fat diet?

A

no

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16
Q

does fatty acid diarrhea respond to a low fat diet?

A

yes

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17
Q

dietary fat is composed exclusively of

A

long chain triglycerides

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18
Q

assimilation of dietary lipids requires 3 phases:

A
  1. intraluminal (digestive)
  2. mucosal (absorptive)
  3. delivery (post absorptive)

abnormality of any of these may cause steatorrhea

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19
Q

an issue in the digestive phase with lipolysis due to decreased pancreatic lipase

2

can be due to gastrinoma or increased bicarb

A

chronic pancreatitis
cystic fibrosis

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20
Q

an issue in the absorptive phase with mucosal uptake and re-esterfication due to impaired movement of mixed micelles

can be due to bacterial overgrowth

A

celiac

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21
Q

issue in the post-absorptive phase with chylomicron formation due to impaired synthesis of B-lipoproteins

A

Abetalipoproteinemia

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22
Q

issue in the post absorptive phase with lipid delivery from the intestine due to abnormal intestinal lymphatics

A

intestinal lymphangiectasia

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23
Q
  • present in coconut oil
  • often used as nutritional supplement
A

medium chain fatty acids

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24
Q

is micelle formation necessary for the digestion of MCTs?

A

no

absorbed directly into cell

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25
Q
  • synthesized by colon bacterial enzyme from non-absorbed carbohydrates
  • rapidly absorbed and stimulat colon NaCl and fluid absorption
A

short chain fatty acids

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26
Q

most antibiotic diarrhea (except C. diff) is caused by a suppression of colonic bacteria resulting in a decrease of

A

SCFAs

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27
Q

lactose requires digestion by

A

brush border lactase

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28
Q

only clinical important disorder of carbohydrate absorption

A

lactose malabsorption

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29
Q

genetically determined decrease or absence of lactase while all other aspects of intestinal absorption and brush border enzymes are normal

A

primary lactase deficiency

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30
Q

caused by diseases that destroy the lining fo the small intestine along with the enzymes

A

secondary lactase deficiency

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31
Q

secondary lactase deficiency is often see in what conditions?

4

A
  • celiac
  • crohn’s
  • UC
  • chemo/long antibiotics
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32
Q

persistence of symptoms in an individual who exhibits lactose intolerance after adhering to a strict lactose free diet indicates

A

IBS

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33
Q

most individuals with primary lactase deficiency do not have

A

symptoms

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34
Q

due to a congenital absence of brush border SGLT1

A

glucose and galactose malabsorption

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35
Q

due to absence of the enzyme that converts trypsin to trypsinogen

A

enterokinase deficiency

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36
Q

associated with diarrhea, growth retardation, and hypoproteinemia

A

enterokinase deficiency

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37
Q
  • due to a defect in nonpolar amino acids
  • pellagra-like rash, neuropsych symptoms
A

hartnup’s syndrome

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38
Q
  • due to a defect in dibasic amino acid transport
  • renal calculi and chronic pancreatitis
A

cystinuria

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39
Q

symptoms of malabsorption in a patient who has recently undergone bowel resection

A

short gut syndrome

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40
Q

steatorrhea in a patient with longstanding alcohol abuse and chronic pancreatitis

A

assess pancreatic exocrine function

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41
Q

gold standard in establishing a diagnosis for steatorrhea

A

timed quantitative stool-fat determination

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42
Q

qualitative test for steatorrhea

A

Sudan III staining

rapid and inexpensive but not as precise

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43
Q

what laboratory studies should be ordered in a patient with suspected malabsorption disorder?

A

CBC
PTT
serum protein
alkaline phosphatase

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44
Q

fat soluble vitamins

A

ADEK

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45
Q

evidence of metabolic bone disease with elevated alkaline phosphatase and/or reduced calcium

A

vitamin D malabsorption

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46
Q

elevated PTT in an individual without liver disease that is not taking anti-coags might indicate

A

vitamin K deficiency

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47
Q

macrocytic anemia might indicate

A

cobalmin or folic acid malabsoprtion

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48
Q

iron deficiency anemia in the absence of occult bleeding might indicate

2

A

iron malabsorption
celiac

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49
Q
  • test performed to determine the cause of cobalamin malabsorption
  • establishes pernicious anemia
A

Schilling

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50
Q
  • test to assess proximal small-intestinal mucosal function
  • reflects duodenal/jejunal mucosal disease
A

urinary d-Xylose test

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51
Q
  • autoimmune disorder
  • reaction to gluten
  • causes malabsorption
A

celiac

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52
Q
  • anemia
  • osteopenia
  • infertility
  • neurologic symptoms

may indicate…

A

atypical celiac disease

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53
Q
  • abnormal small-intestinal biopsy with proximal-to-distal severity
  • responds to elimination of gluten from diet
A

celiac

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54
Q

absence of HLA-DQ2/8 excludes the diagnosis of

A

celiac

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55
Q

association with gliadin

A

celiac

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56
Q

a 4 week course of […] can induce remission in celiacs

A

prednisolone

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57
Q

failure to responds to all treatments of celiac may indicate

A

intestinal T cell lymphoma
autoimmune enteropathy

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58
Q

associated diseases with celiac

A
  • dermatitis herpetiformis
  • DM1
  • IgA deficiency
  • Down syndrome
  • Turner’s syndrome
59
Q

3 situations that may mandate intestinal resection

A
  1. mesenteric vascular disease
  2. Crohn’s
  3. trauma
60
Q

most bile acids are reabosorbed in the

A

ileum

61
Q
  • abdominal pain
  • fever
  • weight loss
  • increased bile acids in large intestine
A

crohns

62
Q

bacterial overgrowth in the small intestine will results in a fast conversion of […] bile acids to […] bile acids

A

conjugated to
unconjugated

63
Q
  • leads to increases in the thickness of the unstirred water layer in the small intestine
  • results in impaired movement of mixed micelles aross
A

bacterial overgrowth syndromes

64
Q
  • steatorrhea due to abnormal intestinal lymphatics
  • deficiency in delivery of digested fatty acids from the intestine to the lymphatics
A

intestinal lymphangiectasia

65
Q
  • failure to thrive
  • photosensitivity
  • intermittent ataxia
  • nystagmus
  • tremor
A

Hartnup syndrome

66
Q

defect in transport of neutral amino acids

A

hartnup syndrome

67
Q
  • characterized by deficienct transport of tryptophan
  • pellagra-like rash
  • neuropsych symptoms
A

hartnup syndrome

68
Q

deficiency in chylomicron formation due to impaired synthesis of B-lipoproteins

A

abetapoproteinemia

69
Q

defect in transport of dibasic amino acids

A

cystinuria

70
Q

due to absence of brush border enzyme that converts trypsinogen to trypsin

A

enterokinase deficiency

71
Q

test performed for pernicious anemia

A

Schilling

B12 deficiency

72
Q
  • depression
  • irritability
  • abnormal sensations
  • poor muscle function
  • glossitis
  • decreased taste
A

symptoms of B12 deficiency

73
Q

performed to diagnose conditions that prevent the small intestine from absorbing nutrients in food

A

urinary D xylose

74
Q

flat small intestinal mucosal biopsy

A

celiac

75
Q

will celiac have a positive D-xylose test?

A

yes

76
Q

things necessary to establish celiac diagnosis

A
  1. improvement of symptoms on gluten free diet
  2. antibody test
  3. biopsy of small intestine
77
Q

secondary to diminished absorption of one or more dietary nutrients

A

osmotic diarrhea

78
Q

condition when stool fat excretion increases >6% of dietary fat intake

A

steatorrhea

79
Q

diarrhea due to small or large intestinal fluid and electrolyte secretion

A

secretory diarrhea

80
Q

what kind of diarrhea would cease during a prolonged fast?

A

osmotic

81
Q

cobalamin and bile acids are absorbed in the

A

ileum

82
Q

calcium, iron, and folic acid are absorbed in the

A

proximal small intestine

especially duodenum

83
Q

why does steatorrhea not generally occur in short bowel syndrome?

A

hepatic synthesis of bile acid increases to compensate for the rate for fecal bile acid losses

84
Q

[…] develops if the degree of ileum resected is extensive

A

fatty acid diarrhea

hepatic synthesis can no longer maintain bile acid pool

85
Q

steatorrhea with decreased pancreatic lipase secretion

A

chronic pancreatitis

86
Q

deficiency in delivery of digested fatty acids from the intestine to the lymphatic vesicles

A

intestinal lymphangiectasia

87
Q

steatorrhea results from impaired synthesis of B-lipoproteins and impaired chylomicron function

A

abetalipoproteinemia

88
Q

steattorhea occurs due to increased thickness of unstirred water layer in small intestine and impaired movement of micelles

A

bacterial overgrowth syndromes

89
Q

catalyzes the hydrolysis of starch into sugars

A

pancreatic amylase

90
Q

SGLT1 transports..

A

glucose
galactose

91
Q

fructose comes into the cell via facillitated diffusion with what transporter?

A

GLUT5

92
Q
  • bowed legs
  • bone pain
  • trouble sleeping
  • elevated alk phos

suggests what deficiency

A

vitamin D

93
Q

macrocytic anemia suggests what deficiency

A

cobalamin or folic acid

94
Q

elevated PTT suggests what deficiency

A

vitamin K

95
Q
  • weight loss
  • diarrhea
  • joint pain
  • arthritis
  • foamy macrophages in lamina propria
A

whipple’s

96
Q

foamy macrophages in lamina propria that are seen on acid-Schiff staining

A

whipple’s

97
Q
  • short/absent villi
  • mononuclear infiltrate
  • epithelial cell damage
  • hypertrophy of crypts
A

celiac

98
Q

responds to pancreatic enzyme treatment

A

chronic pancreatitis

99
Q

which HLA types are associated with celiac?

A

HLA-DQ2
HLA-DQ8

100
Q

changes in intestinal anatomy leading to anatomic stasis can cause

A

bacterial overgrowth syndrome

101
Q

direct communication between the small bowel and large intestine can cause

due to ileocolonic resection

A

bacterial overgrowth syndrome

102
Q

impaired peristalsis leading to functional stasis can cause

A

bacterial overgrowth syndrome

103
Q

most common bacteria in SIBO

A

bacteroides or E. coli

104
Q

bile acid diarrhea in the absence of ileal inflammation/resection will have an abnormal […] study

A

755eHCAT retention

105
Q

bile acid diarrhea in the absence of ileal inflammation/resection will have an reduced ileal release of […]

A

FGF19
(negative regulator of bile acid synthesis )

causes excessive bile acid synthesis

106
Q

diarrhea in patient with abnormal 755eHCAT retention and reduced FGF19 will responsd to

A

cholestyramine

107
Q

persistent of lacose intolerance symptoms even after elminating lactose from diet may indicate

A

IBS

108
Q

defect in transport of dibasic amino acids

A

cystinuria

109
Q

associated with renal calculi and chronic pancreatitis

A

cystinuria

110
Q

what vitamin deficiencies does celiac often present with?

A

iron
folate
vitamin D
Ca+

111
Q

what condition is a celiac particularly at risk for?

A

osteoporosis

112
Q

what is the underlying cause of malabsorption in SIBO?

A

deconjugation of bile acid, preventing reabsorption in ileum and depleting normal bile acid pool

113
Q

what deficiency can cause neuropathies and sensory ataxia

A

B12

114
Q

what deficiency can cause night blindness?

A

vitamin A

115
Q

what deficiency can cause hypocalcemia?

A

vitamin D

116
Q

what deficiency can cause nerve and muscle damage resulting loss of body movement control, weakness, vision problems, and weakened immune system?

A

vitamin E

117
Q

what deficiency can cause anemia?

A

iron, B12

118
Q

what deficiency can cause beriberi?

A

B1

119
Q

what deficiency can cause pellagra?

A

B3

120
Q

patients with celiac may be deficient in […] because they are often found in wheat products

A

B vitamins

121
Q

dietary fat is usually composed of

A

long chain triglycerides

122
Q

synthesized by colonic enzymes from unabsorbed carbohydrates

A

short chain triglycerides

123
Q

digestion of long chain triglycerides requires

A

pancreatic lipolysis and micelle formation

124
Q

medium/short chain triglycerides do not require

A

lipolysis

125
Q

steatorrhea is defined as a condition when stool fat excretion increases to what percentage?

A

> 7%

126
Q

what kind of diarrhea will not respond to a prolonged fast?

A

secretory

127
Q

gram positive actinobacteria

A

T. whipplei

128
Q

both anatomical and functional stasis can contribute to

A

bacterial overgrowth syndromes

129
Q

initial treatment of short-bowel syndrome includes

A
  • establishing effective diet
  • judicious use of opiates to reduce stool output
130
Q

removal of the ileocecal valve causes severed diarrhea due to

3

A
  • increased bile acids
  • decreased transit time
  • bacterial overgrowth from colon
131
Q

test used to determine intestinal lesions, as well as cellular and histological abnormalities

A

biopsy of small intestine mucosa

132
Q

test for pernicious anemia
detects cobalamin malabsorption

A

schilling test

133
Q

test for carbohydrate absorption

A

D-xylose test

134
Q

what deficiency can cause night blindness, dry kin, dry eyes, frequenct infections?

A

vitamin A

135
Q

what deficiency can cause macrocytic anemia?

A

cobalamin

136
Q

what deficiency can cause elevated alk phos and reduced calcium levels?

A

vitamin D

137
Q

absence of SGLT1 causes malabsorption of

A

glucose
galactose

138
Q

fructose is absorbed by

A

GLUT5

139
Q

most individuals with lacotse deficiency do not have

A

symptoms

140
Q

chronic pancreatitis patients often develop steatorrhea due to impairment of

A

lipolysis

141
Q

removes bile acids by forming insoluble complexes with bile acids to be excreted in feces

A

cholestyramine

142
Q

steatorrhea in bacterial overgrowth syndrome is a result of

A

failure to maintain duodenal conjugated bile acid concentrations

143
Q

conjugate bile acids have a lower crictical micellar concentration than unconjugates and area more effective in

A

micelle formation

144
Q

bile acids are absorbed in the

A

ileum

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