Disorders of absorption Flashcards
Whipple disease- Eti
- Rare multisystem illness
- Bacillis Tropheryma whippelii
- Unknown source of infection
Whipple disease- Sx
- Abd pain, diarrhea, malabsorption with distension, flatulence & steatorrhea
- Arthralgia
- Lymphadenopathy
- Wt loss
- Myocardial involvement- murmurs
- CNS involvement
Whipple disease- Dx
- Endoscopic biopsy of duodenum- PAS macrophages
- PCR
Whipple disease- Tx
Cefttriaxone, TMP-sulfa
Short bowel syndrome- Eti
- Malabsorption following small intestine resection
- Chrons, infarction, radiation, trauma
Short bowel syndrome- Sx
- Low vit B12
- Malabsorption of fat soluble vitamins
- kidney stones
- Watery diarrhea
Short bowel syndrome- Dx
- Hx & symptoms
Short bowel syndrome-Tx
- Vitamin supplements
- Bile acid binding salts
- low fat diet
Celiac sprue- Eti
- 1:100 whites
- Dx in 10%
- ID at any age
Celiac sprue- Sx
- Diarrhea, steatorrhea, wt loss, abd distension, weakness, muscle wasting
- Dyspepsia, flatulence, wt loss
- Fatigue
- Iron anemia
- Dermatitis herptiformis
- Hyperactive bowel sounds
Celiac sprue- Dx
- Endoscopic biopsy of duodenum
- IgA serology when consuming gluten
Celiac sprue- Tx
- Remove gluten
- Avoid dairy
- Supplements
Acute diarrhea- Eti
- Duration < 2-3 weeks
- Commonly infectious- hx may reveal org.
- Inflammatory or non
Acute Inflammatory diarrhea-Org
- Shigellosis, salmonellaosis, campy, yersinia or toxin E.coli
Acute inflammatory diarrhea- Sx
- Fecal leukocytes & blood
- LLQ cramps, urgency & tenesmus
Acute non-inflammatory diarrhea- Orgs
- Viruses
- preformed toxins (B. cereus, clostridium, S. aureus
- Protozoa
Acute non-inflammatory diarrhea- Sx
- No blood or fecal leukocytes
- Voluminous diarrhea, cramps, N/V
- Dehydration, hypokalemia & acidosis
Acute inflammatory diarrhea- Dx
- O & P, culture and hx to determine org.
- Commonly self limited
Acute diarrhea- Tx
- Antidiarrheal in non-inflammatory
- Abx
- Opioids
- Fluids & BRAT diet
Chronic diarrhea- Eti
> 4 weeks
- Lactase deficiency?
Chronic diarrhea- Sx
- Osmotic, secretory, inflammatory or malabsorption
Chronic diarrhea- Dx
- Determine cause: med, organism,
- CBC, LFT, INR, Stool studies, colonoscopy
Chronic diarrhea- Tx
- Remove meds, foods that may cause
- Loperamide, tincture of opium, clonidine
Constipation- Eti
- Excessive difficulty defecating, straining
- Fewer than 2 BM/ week
- W>M
- 10-15% adults
- May be due to slowed GI tract or secondary to other systemic disease
Constipation- Sx
- Decreased appetite
- Paradoxical diarrhea
- Firm feces palpable on DRE
- Abd pain & distensio
Constipation- Dx
- Empiric tx if no alarming symptoms
Constipation- Tx
- FIber
- Osmotics
- Surfactants
- Stimulants
Fecal impaction- Eti
- Bowel obstruction due to feces
- Meds, spinal cord disorder, bed rest
Fecal impaction- Sx
- Decreased appetite
- N/V
- leakage
- Firm feces palpable on DRE
Fecal impaction- Tx
- Enemas
- Digital disruption
