Lecture 5: Disorders of the SI/Colon Flashcards
SI anatomy image review
What are the 3 phases of digestion?
- Intraluminal: dietary fats, proteins, carbs are hydrolyzed and solubilized by pancreatic and biliary enzymes
- Mucosal: brush border enzymes hydrolyze peptides and saccharides
- Absorptive
What is celiac disease?
Abnormal IMMUNE response to gluten/gliadin.
Permanent disorder.
Who is at highest risk for celiac disease?
Caucasians
What happens to the SI in celiac disease?
Atrophy of the SI villa and malabsorption of nutrients.
Antibody production will occur as well.
How does classic celiac disease present?
- Diarrhea, steatorrhea, flatulence
- Dyspepsia
- Wt loss
- Abd distension
- Weakness, muscle wasting
- Growth retardation in children
- Resolution of symptoms upon not eating gluten food.
What skin findings are seen in celiac disease?
Dermatitis Herpetiformis (pruitic, papulovesicular rash)
If this is present, good chance they have celiac.
What serology test is the initial workup for celiac disease?
IgA TT antibody test
Extremely sensitive and specific.
Pt should make NO diet changes prior to this test!
What are the secondary serologic antibody tests we might order for celiac disease?
- Total IgA
- IgA anti-endomysial antibody
- IgG DGP
What is the standard way of diagnosing celiac disease with a positive serologic test?
Endoscopic mucosal biopsy of both the proximal and distal duodenum.
Should show blunting or loss of intestinal villi.
What might endoscopy show on imaging for celiac disease?
- Atrophy of duodenal folds
- Nodular, scalloping of duodenal folds, fissuring, mosaic pattern
What causes whipple disease?
- Tropheryma whipplei
- G+, non-acid fast, PAS positive bacillus
- Fecal-oral transmission
How does whipple disease typically present?
- Arthralgias (MC symptom reported first)
- Diarrhea
- Abd pain
- Wt loss (MC SYMPTOM OVERALL)
What PE findings are seen in whipple disease?
- Low-grade fever
- Evidence of malabsorption
- Enlarged joints
- LAN
What is the whipple disease mnemonic?
- Weight loss
- Hyperpigmentation of skin
- Infection with tropheryma whipplei
- PAS positive granules in macrophage
- Polyarthritis
- LAN
- Enteric involvement
- Steatorhhea
WHIPPLES
How do you diagnose whipple disease?
EGD with biopsy of duodenum showing macrophages with PAS bacilli/granules
PCR can confirm if inconclusive
How do you treat whipple disease?
- IV rocephin or meropenem
- Followed by Bactrim for 1 year
What is bacterial overgrowth?
- Colonic bacteria seen in excess in SI.
- Proximal short bowel normally has a small amt of bacteria.
What are the causes of bacterial overgrowth?
- Motility disorders
- Anatomic disorders (adhesions)
- Diabetes
- Immune disorders
What are the common symptoms of small intestinal bacterial overgrowth? (SIBO)
- Nausea
- Bloating
- Gas
- Abd pain
- Fatigue
- Cramps
- Acne rashes
- Wt loss
How do we confirm SIBO?
- Small intestine aspiration w/ cultures (highly invasive)
- Carbohydrate breath test with lactulose and carb cessation
How do you treat SIBO?
- Ciprofloxacin 500mg BID
- Augmentin
- Bactrim
7-10 days
Also, correct anatomic defect if present (like adhesions)
What causes short bowel syndrome? (SBS)
- Removal of a portion of the SI
- Crohn’s, ischemia, tumor, trauma, mesenteric infarction, or volvulus
How does a terminal ileal resection present?
Malabsorption of B12 and bile salts