Celiac Disease, IBS, Lactose Intolerance, & Colon Polyps Flashcards
define celiac disease
malabsorption d/o d/t an autoimmune immunologic response to gliadin (component in gluten)
celiac disease epidemiology
- increased
- 1:113
- whites of N. European descent
- infancy to 70s
celiac disease clinical features
- delayed dx d/t vague sx
- S+S x 10y
- asx = incidental findings (still follow diet tx)
- classic sx = diarrhea, steatorrhea, wt loss, weakness, abd distention, pediatric growth retardation
- atypicl sx = fatigue, depression, delayed puberty, amenorrhea, infertility
- may be related to a specific nutrient deficiency (Fe, Vit K, Vit A, Vit B12)
- coinciding lactose intolerance
- usually normal unless nutrient defiecieny
celiac disease etiology
- idiopathic
- gluten
- genetics
celiac disease diagnostic studies
- sm. intestine bx
- celiac serology (IgA) if (-) = not celiac
- labs to check nutrients
celiac disease treatment
- strict elimination of gluten from diet
- correct nutrient deficiency
- support groups
celiac disease complications
- CA, intestinal lymphoma
- intestinal ulceration
- associated w/ T1DM, Down Syndrome, Turner’s Syndrome, autoimmune
define dermatitis herpetiform
cutaneous varient of celiac dz
dermatitis herpetiform S+S
- pruritic papulovesicles over extensors of extremities, trunk, scalp, and neck
- little to no GI sx
dermatitis herpetiform diagnostic studies
sm. intestine bx
dermatitis herpetiform tx
- dapsone
- gluten free diet
- refer to GI
define irritable bowel syndrome (IBS)
chronic functional diagnosis
- lower abdominal pain and altered bowel habit
- abdominal pain + 2/3: relief w/ defication, change in frequency of BM, or change in BM appearance
irritable bowel syndrome (IBS) epidemiology
- female
- teens/early 20s
irritable bowel syndrome (IBS) etiology
- idiopathic
- dx of exclusion
- abn. motility
- visceral hypersensitivity of abd. area
- enteric infx (S+S w/in 1 year of bacterial gastroenteritis, female, stress)
- psychosocial (depression, anxiety, somatization)
irritable bowel syndrome (IBS) clinical features
- S+S x 3mo
- intermittent, crampy lower abd pain relieved w/ defication
- type of IBS (i.e. w/ diarrhea, w/constipation, mixed)
multitude of other sx - alarm sx = acute onset after 40-50y/o, nocturnal diarrhea, hematochezia, wt. loss, fever, (+) FHx of colon CA, IBD, celiac dz
irritable bowel syndrome (IBS) diagnostic studies
- ROME criteria
- stool for O&P if pt has traveled
- colonoscopy
- if diarrhea type IBS, eval for celiac
irritable bowel syndrome (IBS) tx
- educate + support pt
- reinforce chronic nature
- diet therapy
- psychotics
- probiotics
- move away from finding a cause
- plan to cope w/ sx
- anti-spasmodics
- anti-diarrheals
- anti-constipation
- psych therapies
define lactase deficiency/lactose intolerance
- inability to digest lactose d/t a shortage of lactase
lactose intolerance epidemiology
non-european descent
lactose intolerance pathophysiology
malabsorbed lactose fermented by intestinal bacteria, produces gas and organic acids
- non-metabolized lactose and organic acids incr. osmotic load ==> diarrhea
lactose intolerance etiology
- genetics
- 2nd to GI or surgery affecting sm. intestine mucosa
lactose intolerance clinical features
- bloating
- gas
- diarrhea
- cramping
- RED FLAG: wt loss
lactose intolerance diagnostic studies
- trial of lactose free diet
- hydrogen breath test
lactose intolerance tx
- pt comfort
- some pt can tolerate some lactose
- lactose free diet
- lactase replacement
- Ca supplements
define colon polyps
small clump of cells the form in the lining of the colon
colon polyps epidemiology
- 50+ y/o male
- industrialized nations
- genetics
colon polyps risk factors
- incr. fat diet
- incr diet w/ red meat
- decr fiber diet
- smoking
- obesity
colon polyps types
- hyperplastic
- adenomatous
describe hyperplastic colon polyps
- sm. polyps located in rectum or sigmoid colon
- no malginancy potential
define adenomatous colon polyps
- 2/3 of all polyps
- some cancerous potential
- large lesion = incr CA (greater than 1cm)
How are hyperplastic and adenomatous colon polyps ddx’d?
bx
colon polyps S+S
- asx
- ulcerate –> hematochezia
colon polyps diagnostic studies
- colonoscopy
- polypectomy
- surveillence
