Malabsorption

Question 1

What is the location where B12 and bile salts are reabsorbed?

Answer 1

Terminal ileum.

Question 2

What are the 3 general malabsorption defects?

Answer 2

1. Intraluminal defects: CF, pancreatitis, bile salt deficiency
2. mucosal defects: small bowel disease, resection, or bypass
3. Lymphatic obstruction: lymphomas

Question 3

What is the most common cause of bacterial overgrowth in the terminal ileum that can lead to bile salt insufficiency?

Answer 3

Scleroderma: affects connective tissue and smooth muscle

Question 4

What is celiac sprue?

Answer 4

Autoimmune mucosal defect in response to certain grains mainly containing “gluten or gluten-like” proteins to which autoantibodies are formed. Leads to blunting villi in small bowel and malabsorption.

Question 5

What are the two most common symptoms of celiac sprue that bring patients into the doctor’s office?

Answer 5

1. Diarrhea

2. Dermatitis Herpetiformis: herpes-like skin rash

Question 6

How is celiac sprue diagnosed? (2 things)

Answer 6

Biopsy of small bowel showing blunted villi, then a repeat biopsy after removing gluten from the diet showing regrown villi 3-6 months later.

Serum Ab test to:
Tissue Transglutamase IgA or IgG

Question 7

What is the treatment for celiac sprue?

Answer 7

Diet alteration to remove gluten.

Question 8

What condition very commonly accompanies celiac sprue?

Answer 8

Lactose intolerance: due to lactase enzyme being produced at small intestinal villi tips

Question 9

What is tropical sprue?

Answer 9

Etiology isn’t understood. Most evidence points toward bacterial infection that leads to blunted villi in small bowel.

Question 10

How is tropical sprue treated?

Answer 10

Folic acid supplements and tetracycline for 3-6 months

Question 11

What is Whipple Disease?

Answer 11

Infection of T. whippelii (gram+ bacillus)

• most commonly affects small intestines
• leads to malabsorption, diarrhea, arthralgia, abdominal pain

Question 12

How is Whipple Disease diagnosed?

Answer 12

Small bowel biopsy showing:
-mucosal invading
-gram(+) bacillus
-acid fast
-lymphatic dilation
Also PAS foamy macrophages

Question 13

What is treatment for Whipple Disease?

Answer 13

1. Ceftriaxone IV for 14days

2. Trimethoprine-sulfamethoxazole 2x/day for 1 yr.

Question 14

What can the D-xylose absorption test indicate if positive?

Answer 14

Both sprues and whipple disease