Gastro Flashcards
Clinical presentation of celiac disease
Varies, some are asymptomatic or have only signs of nutritional deficiency. May present at any time between infancy and elderly. Most common between 6-24 months. Infant and childhood (after introduction of cereals in diet): FTT, poor apatite, rickets, apathy, anorexia, pallor, generalized hypotonia, abdominal distention and muscle wasting. Stool are often soft, bulky, clay coloured. Other symptoms: (IDA)anemia, glossititis, angular stomatitis, and aphtous ulcer. Manifestation of Vit D and Ca def = osteomalacia, osteopenia, osteoporosis. Dermatitis herpetiformis. IDA
Celiac disease def: abnormal small intestine mucosa due to intestinal reaction to gliadin, a component of gluten
found in cereal grains.
Celiac disease is a digestive and autoimmune disorder that result in damage to the lining of small intestine when food with gliadin/gluten are eaten, which is a protein found in wheat, rye and barely. (gluten is broken down to gliadin) In genetically susceptible person, gluten sensitive T cells are activated when gluten derived peptide epitops are presented, causing mucosal villous atrophy in small bowel. Associated with HLA-DQ2 and 8
More common in women and with positive family history
Diagnosis of celiac disease
Clinical and lab showing malabsorption (deficiency or steatorrhea)
BIOPSY= gold standard (second part of duodenum).; lack or shortening of villi (villous atrophy). inc intraepithelial lymphocytes, crypt hyperplasia
Serologic markers: anti-tissue transglutaminase 2 antibodies and antiendomysial ab. (antibody against an intestinal CT protein)
Diagnostic criteria of celiac disease
Diagnosed without biopsy if all are present:
1) clinical symptoms: GI: chronic diarrhea, N/V, distention and abdominal pain. Extra GI: FTT/poor growth. chronic anemia, osteopenia, fatigue, glositits, angular stomatitis dermatitis herpetiformis
2) anti-tissue transglutaminase 2 antibodies
3) antiendomysial Ab positive.
4) HLA DQ2 or 8 positive
Treatment of celiac disease
Gluten free diet, symptoms resolve in 1-2 weeks. give nutritional/vit supplementation of deficient.
Cow milk protein allergy
Def;
Adverse immune reaction to cow milk protein that is normally harmless to non allergic individuals
Lactose intolerance
def:
Due to lactase deficiency, resulting in inability to break down sugar in milk and some dairy products. It is an non-allergic food sensitivity
clinical manifestations of lactose intolerance
chronic, watery diarrhea Nausea abdominal pain bloating associated with dairy intake Borborygmi: rumbling stomach
Types of lactose intolerance
Primary lactose intolerance: (older CHILDREN) MCC, Genetic cause
Secondary lactose intolerance: older INFANT, persistent diarrhea (Ass with injury to the small intestine: post viral/bacterial infection,
Celiac disease, or IBD, chemotherapy, environmental)
Diagnosis of lactose intolerance
trial of lactose free diet
Hydrogen breath test if > 6 yrs
stool acidity test
measuring blood glucose levels
Cow milk protein allergy:
etiology
1) IgE mediated (type 1 hypersensitivity): symptoms within 2 hours, Lab: high IgE (total and ant cow milk)
2) non IgE mediated: symptoms develo later: 48 h -1 W: Type 3 ab-ag complex, or type 4 delayed.
Cow milk protein allergy
Clinical:
Vomiting, diarrhea, (IDA)anemia, blood in stool, abdominal pain
Skin: urticaria and eczema
FTT because of poor absorption of nutrients
Other eosinophilia, protein loosing enteropathy.
Cow milk protein allergy
Diagnosis.
Skin patch or skin prick test Serum immunoassay: Ig E Fecal eosinophils Food challange test Endoscopy
Treatment of CMPA disease
Limiting cow milk in diet
Hydrolyzed formulas with broken down proteins
In breastfeeding infants with CMPA, mother must exclude all dairy and soy products from her diet
Malabsorption
etiology
Genetically determined: Celiac disease 1 %, CF
Acquired syndromes: CMPA 3 %, Secondary to liver, pancreas, and intestinal disease.
Intermediate: diarrhe, gastroenteritt, irritable bowel syndrome
Malabsorption
evaluation
From birth? after introduction of new food?
fat absorption: Steatorrhea –> pancreatic insufficency, CF w/ sweat test
Protein loss: CMPA
Breath hydrogen test: lactose intolerance
Acute diarrhea
def
Increased frequency (>6/d) and decreased consistency: lasting
Gastroenterititis
Inflammation of digestive tract that result in V/D, sometimes accompanied by fever or abdominal cramps.
causes of bloody diarrhea
Camplyobacter, E. histolytica, Shigella, salmonella, E.coli (EHEC)
Bacterial vs viral gastroenterititis
Bacterial: high fever, diarrhea, abdominal pain, malaise, severe dehydration
Viral: URTI then, 3-7 d of Vomiting and watery diarrhea (rota v MCC
Non infectious causes of diarrhea
NSAIDS, Lactose intolerance, Celiac disease, AB use, CF.
