Malabsorption Flashcards

Question

چه W/Uی داریم که ساده و کافی باشه برای تشخیص moderate to severe pancreatic insufficiency?

Answer 1

The measurement of pancreatic enzymes (i.e., fecal elastase 1) in the stool

Answer 2

Abdominal Xray or CT Pancreatic calcifications indicate the presence of chronic pancreatitis.

Answer 3

Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) can help outline abnormal duct anatomy and may supplement CT scanning for diagnostic purposes to evaluate the sequelae of chronic pancreatitis. However, normal findings on pancreatography do not exclude the presence of pancreatic exocrine insufficiency.

Answer 4

Whipple disease Amyloidosis Eosinophilic enteritis Lymphangiectasia Primary intestinal lymphoma Giardiasis Abetalipoproteinemia Agammaglobulinemia Mastocytosis

Answer 5

Celiac disease Systemic sclerosis Radiation enteritis Bacterial overgrowth syndrome Tropical sprue Crohn’s disease

Answer 6

معمولا Nonspecific ``` jejunal diverticulosis, lymphoma, Crohn’s disease, strictures, or enteric fistulas. ```

Answer 7

active bowel inflammation mesenteric stranding and edema, strictures fibrofatty proliferation of the mesentery fistula formation.

Answer 8

in patients in whom a stricture is suspected because of the risk of retention.

Answer 9

gastric parietal cells secrete intrinsic factor, which mixes with the ingested meal. In the duodenum, pancreatic trypsin hydrolyzes the R-protein, freeing the vitamin to bind with intrinsic factor.

Answer 10

The vitamin B12–intrinsic factor complex is then absorbed by specific receptors that are found only on enterocytes in the distal ileum. Malabsorption of vitamin B12 can occur because of The Schilling test quantifies vitamin B12 absorption using radiola- beled vitamin B12 as a marker. The test may be expanded to several stages to amplify its diagnostic spectrum. In stage 1, after the injection of 1000 μg of unlabeled vitamin B12 to saturate hepatic storage, the patient ingests 0.5 μg of radiolabeled vitamin. Urine is then collected for the measurement of radioactivity; reduced radioactivity suggests B12 malabsorption. The test is repeated (stage 2) with the addition of oral intrinsic factor to the ingested vitamin B12. If urinary excretion of the radiolabel is corrected, pernicious anemia is diagnosed. If mal- absorption is still present, the patient is given a short course of oral antibiotics (stage 3), and the test is repeated; correction of radiolabeled B12 excretion establishes bacterial overgrowth. If the test result remains abnormal, oral pancreatic enzymes are given (stage 4) and the test is repeated; correction of the abnormality at this stagei implies pancreatic deficiency. Finally, if all these interventions fail, ileal disease or absence of transcobalamin protein is determined by other diagnostic tests, including assessment for intrinsic factor antibodies or Helicobacter pylori infection. This long outline serves merely as an example of an algorithm of clinical analysis; the usual routine in clinical settings is to administer parenteral vitamin B12 while the etiology is delineated by other modalities.

Answer 11

lack of intrinsic factor (e.g., pernicious anemia, gastric resection), pancreatic insufficiency, bacterial overgrowth, or ileal resection or mucosal disease (e.g., Crohn’s disease).

Answer 12

The d-xylose test serves as an indicator of mucosal absorption in the proximal small bowel and is used to determine whether defects in the epithelium of the intestine are responsible for malabsorption.

Answer 13

In this test, the subject ingests 25 g of d-xylose, and urine is collected for the next 5 hours. Healthy subjects excrete more than 4.5 g of d-xylose in 5 hours (or ≥20% of the ingested load). Excretion of a lower amount of d-xylose suggests abnormal absorption.

Answer 14

impaired renal excretory function, gastroparesis, massive peripheral edema, ascites, aspirin, neomycin, indomethacin, and glipizide.

Answer 15

bacterial overgrowth as a result of bacterial degradation of d-xylose in the lumen, but this “pseudomalabsorption” may be corrected after treatment with antibiotics serving as a therapeutic trial.

Answer 16

72 hour fecal fat analysis

Answer 17

لاکتاز دفیشنسی BOS Breath tests rely on bacterial degradation of luminal compounds, which releases metabolic byproduct gases (e.g., hydrogen, methane, carbon dioxide) that can be measured in the exhaled breath. estimate the malabsorption of fat or bile acids and for measurement of bacterial overgrowth (14C-xylose).

Answer 18

Cramps flatulence diarrhoea

Answer 19

Measurement of breath | Hydrogen

Answer 20

کربوهیدرات و اسید چرب

Answer 21

Fat malabsorption

Answer 22

دی زایلوز normal d-xylose test result makes diffuse mucosal disease unlikely and suggests maldigestion, principally pancreatic enzyme or bile salt deficiency.

Answer 23

a history of alcohol abuse or previous episodes of pancreatitis. Unusual causes of pancreatic malabsorption, such as cystic fibrosis, microlithiasis, or drug toxicity, require specific testing and a detailed history.

Answer 24

Serum enzyme tests and abdominal imaging (plain films or, with much greater sensitivity, abdominal CT scans) can be obtained next to identify pancreatic disease.

Answer 25

the breath hydrogen test may be used to diagnose bacterial overgrowth using glucose for the carbohydrate load.

Answer 26

mucosal biopsy

Answer 27

careful stool examination for ova and parasites or fecal antigen studies. such as Giardia lamblia, or ascariasis involvement of the pancreatic duct

Answer 28

intestinal mucosal injury resulting from gluten-related immunologic damage in persons genetically predisposed to this condition. The exposure initiates a cellular immune response that results in mucosal damage Particularly in the proximal Intestine

Answer 29

HLA class ii HLA-DQ8 HLA-DQ2

Answer 30

Tissue transglutaminase

Answer 31

💗nonspecific GI symptoms: ▪️bloating, ▪️chronic diarrhea (with or without steatorrhea), ▪️flatulence, ▪️lactose intolerance, ▪️ deficiencies of a single micronutrient (e.g., iron deficiency anemia). ``` 💗Extraintestinal complaints such as ▪️depression, ▪️weakness, ▪️fatigue, ▪️arthralgias, ▪️osteoporosis, ▪️osteomalacia may predominate. ```

Answer 32

dermatitis herpetiformis type 1 diabetes mellitus autoimmune thyroid disease selective immunoglobulin A (IgA) deficiency

Answer 33

Intestinal biopsy

Answer 34

may show the typical features of broad and flattened villi

Answer 35

pathologic changes ranges from normal villous architecture with an increase in mucosal lymphocytes and plasma cells (the infiltrative lesion) to partial blunting or total villous flattening.

Answer 36

particularly because most other conditions that can mimic celiac disease may be distinguished clinically.

Answer 37

Crohn’s disease gastrinoma lymphoma tropical sprue Graft-versus-host disease immune deficiency

Answer 38

A clinical response to a gluten-free diet establishes the diagnosis and precludes the need, in adults, to document healing by repeated biopsies.

Answer 39

1-patients with atypical symptoms 2-asymptomatic relatives of patients with celiac disease.

Answer 40

حساسیت بالا | اختصاصیت پایین

Answer 41

Persistent symptoms despite a gluten-free diet those who are seronegative

Answer 42

Follow-up monitoring with serologic testing should be done after 3 to 6 months in the first year and then yearly thereafter in stable patients clinically responding to a gluten-free diet.

Answer 43

``` 1-inflammatory bowel disease, 2-microscopic colitis, 3-lactose intolerance, 4-pancreatic insufficiency, 5-ulcerative jejunitis. ```

Answer 44

persistent celiac disease activity despite adherence to a strict gluten-free diet for 12 months

Answer 45

Type 1 RCD is characterized by normal intraepithelial lymphocytes and a polyclonal T-cell receptor population. Type 2 RCD is described as having aberrant intraepithelial lymphocytes with monoclonal T-cell receptors. که طبیعتا پروگنورش بدتره و مورتالیتی ۵ ساله ش بیشتره و More association with lymphoma

Answer 46

``` azathioprine, steroids, methotrexate, cyclosporine, alemtuzumab, cladribine or fludarabine with or without autologous stem cell transplant. ```

Answer 47

Diarrhea malabsorption

Answer 48

(1) deconjugation of bile salts, which leads to impaired micelle formation and impaired uptake of fat; (2) patchy injury to the enterocytes (3) direct competition for the use of nutrients (e.g., uptake of vitamin B12 by gram-negative bacteria or the fish tapeworm Diphyllobothrium latum); (4) stimulated secretion of water and electrolytes by products of bacterial metabolism, such as hydroxylated bile acids and short-chain (volatile) organic acids.

Answer 49

gastric acidity peristalsis intestinal immunoglobulins (IgA).

Answer 50

🐥motility disorders (e.g., scleroderma, amyloidosis, diabetes mellitus) + opiates 🐥anatomic changes (e.g., surgically created blind loops, obstruction, jejunal diverticulosis).

Answer 51

Ongoing weight loss or a steatorrhea | despite enzyme replacement therapy

Answer 52

Direct culture of jejunal aspirate

Answer 53

The 14C-xylose breath test is an accurate and sensitive laboratory test; measurement of breath hydrogen after an oral challenge with glucose is simpler but not as sensitive or as specific.

Answer 54

Rifaximin, amoxicillin-clavulanate, quinolone, metronidazole with a cephalosporin or trimethroprim-sulfamethoxazole

Answer 55

۷ تا ۱۰ روز

Answer 56

🦋bile acid–binding resins, such as cholestyramine and colestipol 🦋 lipase inhibitors orlistat (Xenical) and ezetimibe (Zetia).

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Malabsorption Flashcards

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