Celiac, IBS, Polyps Maclary Flashcards
What is celiac disease?
Malabsorption disorder caused by an immunologic response to gluten
What is gluten?
Storage protein found in wheat, barley, rye
What is the problem with gluten?
Gliadin (a component of gluten)
What populations are most affected by celiac disease?
Whites of Northern European ancestry
Etiology of celiac disease?
- Cause unknown
- Environmental (gluten)
- Genetics (10% in first degree relatives)
What do symptoms of celiac disease depend on?
- How much of SI is affected (delayed diagnosis results in more of intestine affected)
- Age at diagnosis
Fatigue and pallor may relate to which nutrient deficiency?
Iron deficiency anemia
Easy bruising may indicate which nutrient deficiency?
Vit K deficiency
Hyperkeratosis may indicate which nutrient deficiency?
Vit A deficiency
skin cell turnover
Peripheral neuropathy may indicate which nutrient deficiency?
Vit B12 deficiency
Define steatorrhea
Presence of a lot of fat in the stool
What condition may coincide with celiac disease?
Lactose intolerance
What is a cutaneous variant of celiac disease?
Dermatitis herpetiformis
How does dermatitis herpetiformis present?
- Pruritic papulovesicles over extensors of extremities, trunk, scalp, neck
- Little to no GI symptoms
What does a small intestine biopsy of dermatitis herpetiformis show?
Histology consistent with celiac
How is dermatitis herpetiformis treated?
Dapsone
What is the gold standard for diagnosing celiac disease?
Small intestine biopsy (taken from proximal and distal duodenum)
Describe celiac serology
Blood test to check for:
- IgA endomysial antibody
- IgA tissue transglutaminase antibody
- Both are highly sensitive and specific SO
- If negative, celiac disease is ruled out
Treatment of celiac disease
- Strict elimination of gluten from the diet
- Correct any nutritional deficiencies
- Support groups
When will symptoms of celiac disease improve after eliminating gluten from diet?
Within a few weeks
When do antibody levels become undetectable after removing gluten from diet?
3-12 months
What does celiac disease increase the incidence of?
- GI and non GI cancer
- Intestinal lymphoma
What is celiac disease associated with?
- T1DM
- Down Syndrome
- Turner’s Syndrome
- Other autoimmune diseases
What is IBS characterized by?
Abdominal pain and altered bowel habits
What are the criteria required to diagnose IBS?
- ROME criteria
- Must have abdominal pain AND 2 out of 3 below:
1. Relief with defecation
2. Onset a/w a change in BM frequency
3. Onset a/w change in BM appearance - Symptoms must be present for at least 3 months
What populations are most affected by IBS and when is onset typically?
- Females
- Onset late teens, early 20s
Etiologies of IBS?
Could be:
- Abnormal motility (primary motility disorder or secondary reaction to stress)
- Visceral hypersensitivity (low pain tolerance)
- Enteric infection (after episode of bacterial gastroenteritis)
- Psychosocial
What is the psychosocial aspect of IBS?
More than 50% of IBS patients have underlying depression, anxiety, somatization
How long must symptoms be present for before diagnosing IBS?
At least 3 months
How does abdominal pain present in IBS?
- Intermittent
- Crampy
- Lower abdomen
- Relieved by defecation
Types of IBS
- Diarrhea
- Constipation
- Mixed
When should stool be collected in your workup for possible IBS?
If a pt has traveled recently
IBS symptoms that should be cause for concern of something more serious:
- Acute onset after 40-50 yo
- Nocturnal diarrhea
- Hematochezia
- Weight loss and fever
- Fam hx colon cancer, IBD, celiac disease
If someone has predominantly diarrhea IBS, evaluate for:
Celiac disease
Supportive treatment of IBS
- Educate and support pt
- Reinforce chronic nature
- Move away from trying to find a cause
- Make a plan for pt to cope with symptoms
- Diet therapy
What is the diet therapy for IBS?
- Avoid fatty foods and caffeine
- Address lactose intolerance if present
- Certain carbs, fruits, veggies can worsen gas and bloating
When is pharmacotherapy used in IBS?
Reserved for patients with severe symptoms
Pharmacotherapy of IBS
- No standard drug and meds are aimed to tx symptoms
- Anti spasmodics, anti cholinergics (dicyclomine)
- Anti diarrheal (immodium)
- Anti constipation, osmotic laxatives (MOM, linaclotide)
- Tricyclic antidepressants
- Probiotics
Define lactose intolerance
Inability to digest lactose due to a shortage of lactase
What is lactose?
Sugar primarily found in milk and dairy products
What is lactase?
Enzyme found in small intestine that is necessary for lactose digestion
How do levels of lactase vary in humans?
High levels present at birth but steadily decline over time
Which populations are more likely to have lactose intolerance?
Mostly NON European ancestry (Asians, AAs, Native Americans, Mexican, Jewish)
Etiology of lactose intolerance
- Genetic
- Secondary to GI disease or surgery affecting proximal small intestinal mucosa (Crohn’s, Celiac, trauma)
Pathophys of lactose intolerance
- Malabsorbed lactose is fermented by intestinal bacteria producing gas and organic acids
- Non metabolized lactose and organic acids increase stool osmotic load (resulting in diarrhea)
How is lactose intolerance diagnosed?
- Trial of lactose free diet
- Hydrogen breath test
What is the hydrogen breath test?
- To diagnose lactose intolerance
- Pt ingests 50g lactose
- Positive test is a rise in breath hydrogen of 20+ ppm within 90 mins
What does a positive result of hydrogen breath test indicate?
Bacterial carbohydrate metabolism
Treatment of lactose intolerance
- Lactose free diet
- Milk pretreated with lactase
- Lactase enzyme replacement (Lactaid)
- Consider Ca supplement for pts with a very lactose restrictive diet
Describe complete lactose intolerance
Complete intolerance is rare, so many pts can tolerate a small intake of lactose
Define colon polyp
Small clump of cells that form in lining of colon
Which populations are at greater risk of developing colon polyps?
- Men
- Developed nations (high fat diet, red meat, low fiber, cigs, obesity)
- Genetic predisposition
Define hyperplastic colon polyps
- Small
- Located in rectum or sigmoid colon
- No malignancy potential
Define adenomatous colon polyps
- MC type of colon polyp
- Larger lesion is higher risk for cancer
Which type of colon polyp is MC?
Adenomatous
How are types of colon polyps differentiated?
Need a biopsy!
What is the best way to visualize and remove suspicious polyps?
Colonscopy
Define polypectomy and risks
- Removal of polyp via colonoscopy
- Risks of perforation and bleeding
