Celiac and Lactose Flashcards
Patho celiac
-immunologic/ inflammatory response to ingested gluten affecting the GI mucosa
Gluten is
wheat, rye, barley
Area most affected by gluten
proximal small bowel
Clinical Celiac
- diarrhea
- flatulence
- borborygmus
- weight loss, failure to thrive and growth retardation
- weak/fatigue
- severe abdominal pain
- iron deficient anemia
- osteopenia/porosis
- neuro sx
- dermatitis herpetiformis
- amenorrhea, delayed puberty, infertility
PE celiac
- protuberant, tympanic abdomen
- weight loss
- orthostatic hypotension
- peripheral edema(protein malab)
- ecchymosis (vit K def)
- hyperkeratosis (vit A def)
- cheilosis and glossitis (iron def)
- peripheral neuropathy (B12 def)
- Trousseau sign, tetany (Ca2+ def)
Lab testing celiac
CBC CMP Coags- PT prolonged Stool- fat malabsorption Oral tolerance- lactose
Serologic testing in Celiac
IgA TTG- 95% sensitive and specific
IgA- if IgA TTG negative but high suspicion
Less than 2= IgATTG + IgG- deaminated gliadin peptides
When do antibodies become undetectable in celiac
within 3-12mo gluten avoidance
Gold standard tx for celiac
endoscopy and mucosal biopsy
Endoscopy and celiac results
atrophy/ scalloping of duodenal folds
Histology for celiac
villi atrophic/absent
hypertrophy of crypts
increased cellularity of lamina propria
proliferation of plasma cells and lymphocytes
Tx celiac
- diet: remove all gluten and improve in 2 weeks
- supplements in initial stages
- steroids (prednisone or budesonide ) get dz under control
Patho lactose intolerance
- inability to digest lactose
- high levels of lactase at birth but decline steadily with aging, especially people of non-European descent
What is lactase
brush border enzyme that digests lactose into galactose and glucose
Clinical lactose intolerance
- abdominal bloating and cramping
- flatulence
- diarrhea
- nausea
- borborygmia
- sx due to ingestion of lactose
