Clinical Approach - Intestinal Dz Flashcards
What are the four major organs required for fat absorption?
stomach, intestine, pancreas, liver
What are the roles and interactions of the four major organs of fat absorption?
gastric lipase hydrolyzes TGs, forceful contractions create emulsion of fat droplets
pancreatic lipase hydrolyzes TG emulsion in intestinal lumen - solubilized by bile acids from liver to form mixed micelles
everything resynthesized and lipoproteins formed in intestine
What is the clinical presentation of patients with fat malabsorption?
weight loss, diarrhea, steatorrhea, vit and mineral def (esp iron)
How can tropical sprue be recognized as the cause of malabsorption?
B12 and folate def = megaloblastic anemia
How can celiac sprue be recognized as the cause of malabsorption?
loss of villi, intraepithelial lymphocytes, crypt hyperplasia
malabsorption of iron mostly
anti-tissue transglutaminases (tTg) IgA - make sure no IgA def
How can Whipple’s dz be recognized as the cause of malabsorption?
PAS+ in LP
affects lots of other organs
What are the characteristics of secretory diarrhea?
cholera
large volume, persists during fasting, stool osmotic gap <20
What are the characteristics of osmotic diarrhea?
milk of magnesia, ingestion of any poorly absorbed carbs or ions
stool volume 50
What can cause motility or functional diarrhea?
increased bowel motor activity (IBS or hyperthyroidism)
How is inflammatory diarrhea recognized?
blood or pus in stool, WBC in stool
What are the normal results of the stool osmotic gap and how is it calculated?
280 - 2(Na + K)
normal secretory cause
>50 –> osmotic cause
What is present with ileal dysfunction?
bile acid induced diarrhea
How can ischemia be recognized as the cause of malabsorption?
pain after eating
WEIGHT LOSS
small bowel more dangerous than colon –> surgery
